Provider Demographics
NPI:1679226294
Name:SARAH L. SWANLUND, DMD, INC.
Entity Type:Organization
Organization Name:SARAH L. SWANLUND, DMD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SWANLUND
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:309-532-1113
Mailing Address - Street 1:143 N WILLIAMSBURG DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-3528
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:143 N WILLIAMSBURG DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-3528
Practice Address - Country:US
Practice Address - Phone:309-661-1500
Practice Address - Fax:309-661-1520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL019.029030OtherSTATE LICENSE