Provider Demographics
NPI:1275975393
Name:SWANSON DENTAL CORPORATION
Entity Type:Organization
Organization Name:SWANSON DENTAL CORPORATION
Other - Org Name:SWNAON DENAL CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:408-265-6501
Mailing Address - Street 1:3535 ROSS AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-3038
Mailing Address - Country:US
Mailing Address - Phone:408-265-6501
Mailing Address - Fax:408-265-6502
Practice Address - Street 1:3535 ROSS AVE STE 302
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-3038
Practice Address - Country:US
Practice Address - Phone:408-265-6501
Practice Address - Fax:408-265-6502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA516031223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherDENTAL