Provider Demographics
NPI:1700956018
Name:E HAMRICK SWAN JR DMD
Entity Type:Organization
Organization Name:E HAMRICK SWAN JR DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:E
Authorized Official - Middle Name:HAMRICK
Authorized Official - Last Name:SWAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:785-537-9785
Mailing Address - Street 1:1121 WATERS ST
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-2832
Mailing Address - Country:US
Mailing Address - Phone:785-537-9785
Mailing Address - Fax:785-537-1251
Practice Address - Street 1:1121 WATERS ST
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66503-2832
Practice Address - Country:US
Practice Address - Phone:785-537-9785
Practice Address - Fax:785-537-1251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100097510BMedicaid