Provider Demographics
NPI:1710148275
Name:SWETTER, RUSSELL PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:PAUL
Last Name:SWETTER
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 219
Mailing Address - Street 2:46 MAIN ST
Mailing Address - City:CLIFFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18413
Mailing Address - Country:US
Mailing Address - Phone:570-222-4628
Mailing Address - Fax:
Practice Address - Street 1:46 MAIN ST
Practice Address - Street 2:
Practice Address - City:CLIFFORD
Practice Address - State:PA
Practice Address - Zip Code:18413
Practice Address - Country:US
Practice Address - Phone:570-222-4628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS19949L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice