Provider Demographics
NPI:1578084810
Name:SWENSON, RYAN P (DDS)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:P
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 1:805 S ARMSTRONG AVE
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55355-3301
Mailing Address - Country:US
Mailing Address - Phone:720-335-2858
Mailing Address - Fax:
Practice Address - Street 1:715 N SIBLEY AVE
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55355-4560
Practice Address - Country:US
Practice Address - Phone:320-693-2228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND138721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice