Provider Demographics
NPI:1437151156
Name:SWANBERG, ROBERT J (DMC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:SWANBERG
Suffix:
Gender:M
Credentials:DMC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 SE MAIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2448
Mailing Address - Country:US
Mailing Address - Phone:503-254-5593
Mailing Address - Fax:503-253-3878
Practice Address - Street 1:10000 SE MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2448
Practice Address - Country:US
Practice Address - Phone:503-254-5593
Practice Address - Fax:503-253-3878
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2007-11-19
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-04-06
Provider Licenses
StateLicense IDTaxonomies
OR47831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice