Provider Demographics
NPI:1518029016
Name:SWENSON, PETER V (DDS)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:V
Last Name:SWENSON
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 1:4700 LEXINGTON AVE N
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-5844
Mailing Address - Country:US
Mailing Address - Phone:651-483-1858
Mailing Address - Fax:651-766-8400
Practice Address - Street 1:4700 LEXINGTON AVE N
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-5844
Practice Address - Country:US
Practice Address - Phone:651-483-1858
Practice Address - Fax:651-766-8400
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN111031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice