Provider Demographics
NPI:1225384522
Name:SWETT, STEPHANIE RENEE' (BSDH, IPDH)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:RENEE'
Last Name:SWETT
Suffix:
Gender:F
Credentials:BSDH, IPDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 INFANT ST
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-3310
Mailing Address - Country:US
Mailing Address - Phone:207-479-4110
Mailing Address - Fax:
Practice Address - Street 1:21 INFANT ST
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-3310
Practice Address - Country:US
Practice Address - Phone:207-479-4110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEIPH46124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist