Provider Demographics
NPI:1528003647
Name:SWANN, WHITNEY K (DMD)
Entity Type:Individual
Prefix:DR
First Name:WHITNEY
Middle Name:K
Last Name:SWANN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1171A MITCHELL BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-6411
Mailing Address - Country:US
Mailing Address - Phone:706-548-2651
Mailing Address - Fax:706-543-1052
Practice Address - Street 1:1171A MITCHELL BRIDGE RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-6411
Practice Address - Country:US
Practice Address - Phone:706-548-2651
Practice Address - Fax:706-543-1052
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0125471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADN012574OtherDENTAL LICENSE NUMBER