Provider Demographics
NPI:1497067680
Name:SWIFT, MICHELLE E (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:E
Last Name:SWIFT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3308 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-5969
Mailing Address - Country:US
Mailing Address - Phone:337-477-7072
Mailing Address - Fax:
Practice Address - Street 1:4702 JOHNSTON ST STE D
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-4501
Practice Address - Country:US
Practice Address - Phone:337-984-3408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-05
Last Update Date:2010-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA60561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice