Provider Demographics
NPI:1568651685
Name:SWAIN, JOHN K (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:K
Last Name:SWAIN
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 1:1661 S VAL VISTA DR
Mailing Address - Street 2:SUITE # C-101
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-4508
Mailing Address - Country:US
Mailing Address - Phone:480-558-3100
Mailing Address - Fax:480-855-9507
Practice Address - Street 1:1661 S VAL VISTA DR
Practice Address - Street 2:SUITE # C-101
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-4508
Practice Address - Country:US
Practice Address - Phone:480-558-3100
Practice Address - Fax:480-855-9507
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5267122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist