Provider Demographics
NPI:1912969114
Name:SWENSON, ERIC L (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:L
Last Name:SWENSON
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 1:378 E 400 S
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-1980
Mailing Address - Country:US
Mailing Address - Phone:801-489-9456
Mailing Address - Fax:
Practice Address - Street 1:378 E 400 S
Practice Address - Street 2:SUITE 1
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-1980
Practice Address - Country:US
Practice Address - Phone:801-489-9456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7908107-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist