Provider Demographics
NPI:1487627329
Name:SWEARINGEN, GLENN RALPH JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:RALPH
Last Name:SWEARINGEN
Suffix:JR
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 1:210 N 3RD ST
Mailing Address - Street 2:PO BOX 347
Mailing Address - City:TORONTO
Mailing Address - State:OH
Mailing Address - Zip Code:43964-1418
Mailing Address - Country:US
Mailing Address - Phone:740-537-1731
Mailing Address - Fax:
Practice Address - Street 1:210 N 3RD ST
Practice Address - Street 2:
Practice Address - City:TORONTO
Practice Address - State:OH
Practice Address - Zip Code:43964-1418
Practice Address - Country:US
Practice Address - Phone:740-537-1731
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH144791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0277749Medicaid