Provider Demographics
NPI:1417015710
Name:SWANSON, CHRISTINE MARIE (DDS)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MARIE
Last Name:SWANSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 WEST 66TH STREET
Mailing Address - Street 2:SUITE 320
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2530
Mailing Address - Country:US
Mailing Address - Phone:952-927-6477
Mailing Address - Fax:952-927-0890
Practice Address - Street 1:3250 WEST 66TH STREET
Practice Address - Street 2:SUITE 320
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2530
Practice Address - Country:US
Practice Address - Phone:952-927-6477
Practice Address - Fax:952-927-0890
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice