Provider Demographics
NPI:1881725513
Name:SWEARINGEN, JOHN C
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:SWEARINGEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 COLORADO AVE BLDG 3
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-2713
Mailing Address - Country:US
Mailing Address - Phone:209-667-0115
Mailing Address - Fax:209-667-2323
Practice Address - Street 1:1600 COLORADO AVE BLDG 3
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2713
Practice Address - Country:US
Practice Address - Phone:209-667-0115
Practice Address - Fax:209-667-2323
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA284961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice