Provider Demographics
NPI:1760639769
Name:MERRILL SWANSON DDS LLC
Entity Type:Organization
Organization Name:MERRILL SWANSON DDS LLC
Other - Org Name:LEXINGTON DENTAL PARTNERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:419-884-3411
Mailing Address - Street 1:355 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:44904-9543
Mailing Address - Country:US
Mailing Address - Phone:419-884-3411
Mailing Address - Fax:419-884-0656
Practice Address - Street 1:355 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:OH
Practice Address - Zip Code:44904-9543
Practice Address - Country:US
Practice Address - Phone:419-884-3411
Practice Address - Fax:419-884-0656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-20
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0228551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty