Provider Demographics
NPI:1487839130
Name:SWANSON, TOM DUANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:TOM
Middle Name:DUANE
Last Name:SWANSON
Suffix:
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:P.O. BOX 382
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:RI
Mailing Address - Zip Code:02871-1225
Mailing Address - Country:US
Mailing Address - Phone:401-683-0112
Mailing Address - Fax:401-683-2171
Practice Address - Street 1:1985 E MAIN RD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:RI
Practice Address - Zip Code:02871-1225
Practice Address - Country:US
Practice Address - Phone:401-683-0112
Practice Address - Fax:401-683-2171
Is Sole Proprietor?:No
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI19561223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
RITS00046Medicaid