Provider Demographics
NPI:1437285566
Name:LOREN C. SWANSON, D.D.S., S.C.
Entity Type:Organization
Organization Name:LOREN C. SWANSON, D.D.S., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:920-231-8120
Mailing Address - Street 1:2215 OREGON ST
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54902-7060
Mailing Address - Country:US
Mailing Address - Phone:920-231-8120
Mailing Address - Fax:920-231-8296
Practice Address - Street 1:2215 OREGON ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902-7060
Practice Address - Country:US
Practice Address - Phone:920-231-8120
Practice Address - Fax:920-231-8296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50013010151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33614900Medicaid