Provider Demographics
NPI:1700184512
Name:PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:PEDIATRIC DENTISTRY
Other - Org Name:KURT R. SWAUGER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OF PRACTICE
Authorized Official - Prefix:DR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:SWAUGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-824-5047
Mailing Address - Street 1:100 SPRINGHOUSE CT STE 110
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-1610
Mailing Address - Country:US
Mailing Address - Phone:615-824-5047
Mailing Address - Fax:
Practice Address - Street 1:100 SPRINGHOUSE CT STE 110
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-1610
Practice Address - Country:US
Practice Address - Phone:615-824-5047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN78991223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty