Provider Demographics
NPI:1497067698
Name:SWENSON, SARAH ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:ELIZABETH
Last Name:SWENSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SARAH
Other - Middle Name:ELIZABETH
Other - Last Name:MURRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2656 COUNTRY CLUB PKWY SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-1643
Mailing Address - Country:US
Mailing Address - Phone:319-531-0963
Mailing Address - Fax:
Practice Address - Street 1:1962 1ST AVENUE NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5334
Practice Address - Country:US
Practice Address - Phone:319-364-2413
Practice Address - Fax:319-364-8179
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IA087651223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program