Provider Demographics
NPI:1134096068
Name:SWENSON PERIODONTICS PLLC
Entity type:Organization
Organization Name:SWENSON PERIODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PERIODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANE
Authorized Official - Middle Name:T
Authorized Official - Last Name:SWENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:970-462-6132
Mailing Address - Street 1:1825 VILLAGE CENTER CIR STE 150
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-0575
Mailing Address - Country:US
Mailing Address - Phone:702-660-0024
Mailing Address - Fax:
Practice Address - Street 1:1825 VILLAGE CENTER CIR STE 150
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-0575
Practice Address - Country:US
Practice Address - Phone:702-660-0024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-23
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty