Provider Demographics
NPI:1457427189
Name:SWENSON, LAWRENCE DEAN (DDS)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:DEAN
Last Name:SWENSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:LARRY
Other - Middle Name:DEAN
Other - Last Name:SWENSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:MANSON
Mailing Address - State:IA
Mailing Address - Zip Code:50563
Mailing Address - Country:US
Mailing Address - Phone:712-469-3000
Mailing Address - Fax:712-469-2552
Practice Address - Street 1:1303 11TH AVENUE
Practice Address - Street 2:
Practice Address - City:MANSON
Practice Address - State:IA
Practice Address - Zip Code:50563
Practice Address - Country:US
Practice Address - Phone:712-469-3000
Practice Address - Fax:712-469-2552
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA60751223G0001X
WADE000065761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice