Provider Demographics
NPI:1497853105
Name:SWANSTROM, JAMES RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RICHARD
Last Name:SWANSTROM
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 1:5934 N. PIKE LAKE ROAD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811
Mailing Address - Country:US
Mailing Address - Phone:218-724-2947
Mailing Address - Fax:
Practice Address - Street 1:601 HIGHWAY 73
Practice Address - Street 2:SCENIC RIVERS DENTAL
Practice Address - City:FLOODWOOD
Practice Address - State:MN
Practice Address - Zip Code:55736
Practice Address - Country:US
Practice Address - Phone:218-476-2969
Practice Address - Fax:218-476-1599
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN79241223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice