Provider Demographics
NPI:1235333683
Name:SWEEN, MARK DUANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:DUANE
Last Name:SWEEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3548 NOBLE AVE N
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55422-2866
Mailing Address - Country:US
Mailing Address - Phone:763-521-2254
Mailing Address - Fax:763-521-5263
Practice Address - Street 1:3548 NOBLE AVE N
Practice Address - Street 2:
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55422-2866
Practice Address - Country:US
Practice Address - Phone:763-521-2254
Practice Address - Fax:763-521-5263
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND124111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice