Provider Demographics
NPI:1639358021
Name:LAVERN H. SWENSON DDS
Entity Type:Organization
Organization Name:LAVERN H. SWENSON DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAVERN
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:SWENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-452-4615
Mailing Address - Street 1:618 S PEABODY ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-6244
Mailing Address - Country:US
Mailing Address - Phone:360-452-4615
Mailing Address - Fax:360-452-0764
Practice Address - Street 1:618 S PEABODY ST
Practice Address - Street 2:SUITE A
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-6244
Practice Address - Country:US
Practice Address - Phone:360-452-4615
Practice Address - Fax:360-452-0764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00004802261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental