Provider Demographics
NPI:1205000619
Name:BRYAN D. SWEEN, DDS
Entity Type:Organization
Organization Name:BRYAN D. SWEEN, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:SWEEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:763-757-3430
Mailing Address - Street 1:1557 COON RAPIDS BLVD NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-4799
Mailing Address - Country:US
Mailing Address - Phone:763-757-3430
Mailing Address - Fax:
Practice Address - Street 1:1557 COON RAPIDS BLVD NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-4799
Practice Address - Country:US
Practice Address - Phone:763-757-3430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10941305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization