Provider Demographics
NPI:1528385168
Name:SWANSON, WILLIAM MAURICE (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MAURICE
Last Name:SWANSON
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 1:2521 JONATHAN RD
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-1825
Mailing Address - Country:US
Mailing Address - Phone:410-465-7612
Mailing Address - Fax:410-465-7612
Practice Address - Street 1:2521 JONATHAN RD
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-1825
Practice Address - Country:US
Practice Address - Phone:410-465-7612
Practice Address - Fax:410-465-7612
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-21
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD5896122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist