Provider Demographics
NPI:1841308939
Name:SWAIN DENTAL PA
Entity type:Organization
Organization Name:SWAIN DENTAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SWAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-716-1350
Mailing Address - Street 1:134 PASADENA ROAD
Mailing Address - Street 2:
Mailing Address - City:WHITING
Mailing Address - State:NJ
Mailing Address - Zip Code:08759
Mailing Address - Country:US
Mailing Address - Phone:732-716-1350
Mailing Address - Fax:732-716-1346
Practice Address - Street 1:20 HOSPITAL DRIVE
Practice Address - Street 2:SUITE 20
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755
Practice Address - Country:US
Practice Address - Phone:732-716-1350
Practice Address - Fax:732-716-1346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2671000Medicaid