Provider Demographics
NPI:1376962613
Name:SWEARINGEN, JOHN CHRISTOPHER (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CHRISTOPHER
Last Name:SWEARINGEN
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 1:780 RIDGE LAKE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9426
Mailing Address - Country:US
Mailing Address - Phone:901-682-8431
Mailing Address - Fax:901-682-2345
Practice Address - Street 1:780 RIDGE LAKE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120
Practice Address - Country:US
Practice Address - Phone:901-682-8431
Practice Address - Fax:901-682-2345
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN104411223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty