Provider Demographics
NPI:1619191467
Name:SWAN, JOEL P (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:P
Last Name:SWAN
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:PO BOX 338
Mailing Address - Street 2:
Mailing Address - City:PINE ISLAND
Mailing Address - State:MN
Mailing Address - Zip Code:55963-0338
Mailing Address - Country:US
Mailing Address - Phone:507-356-4206
Mailing Address - Fax:507-356-2009
Practice Address - Street 1:232 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PINE ISLAND
Practice Address - State:MN
Practice Address - Zip Code:55963-9190
Practice Address - Country:US
Practice Address - Phone:507-356-4206
Practice Address - Fax:507-356-2009
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN90911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice