Provider Demographics
NPI:1871833467
Name:SWENSEN, NATHAN EZRA (DMD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:EZRA
Last Name:SWENSEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 MELARKEY ST
Mailing Address - Street 2:SUITE #9
Mailing Address - City:WINNEMUCCA
Mailing Address - State:NV
Mailing Address - Zip Code:89445-3178
Mailing Address - Country:US
Mailing Address - Phone:775-623-5093
Mailing Address - Fax:
Practice Address - Street 1:530 MELARKEY ST
Practice Address - Street 2:SUITE #9
Practice Address - City:WINNEMUCCA
Practice Address - State:NV
Practice Address - Zip Code:89445-3178
Practice Address - Country:US
Practice Address - Phone:775-623-5093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-19
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV64541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice