Provider Demographics
NPI:1013053024
Name:SWARTS, ROBERT GLENDON (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GLENDON
Last Name:SWARTS
Suffix:
Gender:M
Credentials:DDS,MS
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 450
Mailing Address - Street 2:450 OLD ABE ROAD
Mailing Address - City:LAC DU FLAMBEAU
Mailing Address - State:WI
Mailing Address - Zip Code:54538-0450
Mailing Address - Country:US
Mailing Address - Phone:715-588-4280
Mailing Address - Fax:715-588-2269
Practice Address - Street 1:W12802 COUNTY HIGHWAY A
Practice Address - Street 2:
Practice Address - City:BOWLER
Practice Address - State:WI
Practice Address - Zip Code:54416
Practice Address - Country:US
Practice Address - Phone:715-793-4144
Practice Address - Fax:715-793-5044
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010114271223G0001X
WI66401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI6640OtherWI DENTAL LICENSE
MI195816016OtherBCBS MEDICAL PROVIDER NUM