Provider Demographics
NPI:1437307931
Name:KATHRYN A. SWAN, D.D.S., M.S., P.C.
Entity Type:Organization
Organization Name:KATHRYN A. SWAN, D.D.S., M.S., P.C.
Other - Org Name:SWAN ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:SWAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:616-698-2323
Mailing Address - Street 1:6677 CROSSINGS DR SE
Mailing Address - Street 2:SUITE #2
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-7889
Mailing Address - Country:US
Mailing Address - Phone:616-698-2323
Mailing Address - Fax:616-871-9253
Practice Address - Street 1:6677 CROSSINGS DR SE
Practice Address - Street 2:SUITE #2
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-7889
Practice Address - Country:US
Practice Address - Phone:616-698-2323
Practice Address - Fax:616-871-9253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-09
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010190441223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1831209931OtherNPI
MI1164618344OtherNPI