Provider Demographics
NPI:1952422602
Name:SWAHN, CLARENCE JOHN III (DMD)
Entity Type:Individual
Prefix:DR
First Name:CLARENCE
Middle Name:JOHN
Last Name:SWAHN
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3580 PEACH ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-2776
Mailing Address - Country:US
Mailing Address - Phone:814-866-9709
Mailing Address - Fax:814-864-9488
Practice Address - Street 1:3580 PEACH ST
Practice Address - Street 2:SUITE 110
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2776
Practice Address - Country:US
Practice Address - Phone:814-866-9709
Practice Address - Fax:814-864-9488
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PADS024934L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist