Provider Demographics
NPI:1588840631
Name:GLENN R SWEARINGEN JR DDS INC
Entity Type:Organization
Organization Name:GLENN R SWEARINGEN JR DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:RALPH
Authorized Official - Last Name:SWEARINGEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:740-537-1731
Mailing Address - Street 1:210 N 3RD ST
Mailing Address - Street 2:PO BOX 347
Mailing Address - City:TORONTO
Mailing Address - State:OH
Mailing Address - Zip Code:43964-1418
Mailing Address - Country:US
Mailing Address - Phone:740-537-1731
Mailing Address - Fax:740-537-1779
Practice Address - Street 1:210 N 3RD ST
Practice Address - Street 2:
Practice Address - City:TORONTO
Practice Address - State:OH
Practice Address - Zip Code:43964-1418
Practice Address - Country:US
Practice Address - Phone:740-537-1731
Practice Address - Fax:740-537-1779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH144791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0277749Medicaid