Provider Demographics
NPI:1720572498
Name:SWANSON, EMILY (DMD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:SWANSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 QUEEN ANNE DR SE
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-1428
Mailing Address - Country:US
Mailing Address - Phone:770-401-6485
Mailing Address - Fax:
Practice Address - Street 1:1201 PEACHTREE ST NE STE 1515
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30361-3514
Practice Address - Country:US
Practice Address - Phone:404-892-3545
Practice Address - Fax:404-875-0349
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1224921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice