Provider Demographics
NPI:1629104823
Name:SWAVELY, BARBARA (RDH)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:SWAVELY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18864 SUNRISE VALLEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191
Mailing Address - Country:US
Mailing Address - Phone:571-217-5911
Mailing Address - Fax:
Practice Address - Street 1:11864 SUNRISE VALLEY DR
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-3310
Practice Address - Country:US
Practice Address - Phone:571-217-5911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402004162124Q00000X
NY0158951124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist