Provider Demographics
NPI:1134524572
Name:NATE SWENSEN DMD LLC
Entity type:Organization
Organization Name:NATE SWENSEN DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SWENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:775-623-5093
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:775-623-9104
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:775-623-9104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV64541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty