Provider Demographics
NPI:1700097607
Name:SWICA, GREGORY (DDS)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:SWICA
Suffix:
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 1:2901 BROOKS ST
Mailing Address - Street 2:SAPPHIRE DENTAL GROUP
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-7722
Mailing Address - Country:US
Mailing Address - Phone:406-541-2886
Mailing Address - Fax:406-541-2889
Practice Address - Street 1:2901 BROOKS ST
Practice Address - Street 2:SAPPHIRE DENTAL GROUP
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-7722
Practice Address - Country:US
Practice Address - Phone:406-541-2886
Practice Address - Fax:406-541-2889
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT21081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice