Provider Demographics
NPI:1790136380
Name:SWARBRICK, JORDAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:
Last Name:SWARBRICK
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 1:395 W 4650 N
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-5529
Mailing Address - Country:US
Mailing Address - Phone:530-748-9384
Mailing Address - Fax:
Practice Address - Street 1:2255 N UNIVERSITY PKWY STE 37
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-1503
Practice Address - Country:US
Practice Address - Phone:801-386-8778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-25
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS2-175C204E00000X
UT11826340-99251223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty