Provider Demographics
NPI:1538286489
Name:SWENSON, GREGORY MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:MICHAEL
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 1:812 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:MIFFLINBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17844-1247
Mailing Address - Country:US
Mailing Address - Phone:570-966-4844
Mailing Address - Fax:
Practice Address - Street 1:312 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:PA
Practice Address - Zip Code:17842-1106
Practice Address - Country:US
Practice Address - Phone:570-837-5117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027560R1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice