Provider Demographics
NPI:1184788614
Name:SWANSON FAMILY DENTRISTRY PA
Entity type:Organization
Organization Name:SWANSON FAMILY DENTRISTRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-545-2838
Mailing Address - Street 1:12450 WAYZATA BLVD
Mailing Address - Street 2:STE 214
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-1934
Mailing Address - Country:US
Mailing Address - Phone:952-545-2838
Mailing Address - Fax:952-545-7649
Practice Address - Street 1:12450 WAYZATA BLVD
Practice Address - Street 2:STE 214
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1934
Practice Address - Country:US
Practice Address - Phone:952-545-2838
Practice Address - Fax:952-545-7649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty