Provider Demographics
NPI:1659374452
Name:SWAIN, FREDERICK RAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:RAY
Last Name:SWAIN
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 1:4010 DUPONT CIR
Mailing Address - Street 2:STE 529
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4888
Mailing Address - Country:US
Mailing Address - Phone:502-897-3239
Mailing Address - Fax:502-897-3476
Practice Address - Street 1:4010 DUPONT CIR
Practice Address - Street 2:STE 529
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4888
Practice Address - Country:US
Practice Address - Phone:502-897-3239
Practice Address - Fax:502-897-3476
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY45191223P0221X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100010800AOtherMEDICAL ASSISTANCE
KY60045192OtherMEDICAL ASSISTANCE
KY4507OtherMEDICAL ASSISTANCE
IN200448OtherCRIPPLED CHILDREN'S SERVI