Provider Demographics
NPI:1396274221
Name:SWARTOUT, JACK CLARK II (DDS)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:CLARK
Last Name:SWARTOUT
Suffix:II
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 CLEAR BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-2158
Mailing Address - Country:US
Mailing Address - Phone:317-490-2896
Mailing Address - Fax:
Practice Address - Street 1:2955 N HIGH SCHOOL RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-2915
Practice Address - Country:US
Practice Address - Phone:317-293-4020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-05
Last Update Date:2017-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012687A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice