Provider Demographics
NPI:1568543189
Name:SWAIN, GENE WILLIAMS JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:GENE
Middle Name:WILLIAMS
Last Name:SWAIN
Suffix:JR
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 1:104 2ND AVE SE
Mailing Address - Street 2:
Mailing Address - City:WASECA
Mailing Address - State:MN
Mailing Address - Zip Code:56093-3041
Mailing Address - Country:US
Mailing Address - Phone:507-835-4280
Mailing Address - Fax:
Practice Address - Street 1:104 2ND AVE SE
Practice Address - Street 2:
Practice Address - City:WASECA
Practice Address - State:MN
Practice Address - Zip Code:56093-3041
Practice Address - Country:US
Practice Address - Phone:507-835-4280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND104061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN156L9ANOtherBLUECROSS/BLUESHIELD