Provider Demographics
NPI:1558311449
Name:SWANSON, ERIK THURSTON (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERIK
Middle Name:THURSTON
Last Name:SWANSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 ROSS AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-3054
Mailing Address - Country:US
Mailing Address - Phone:408-265-4064
Mailing Address - Fax:
Practice Address - Street 1:3535 ROSS AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-3054
Practice Address - Country:US
Practice Address - Phone:408-265-4064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA516571223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics