Provider Demographics
NPI:1982899712
Name:FAMILY SMILES
Entity Type:Organization
Organization Name:FAMILY SMILES
Other - Org Name:JAMES C. SWANSON, PC D. D. S., PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-564-0990
Mailing Address - Street 1:1001 S PUEBLO BLVD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-1682
Mailing Address - Country:US
Mailing Address - Phone:719-564-0990
Mailing Address - Fax:719-564-6817
Practice Address - Street 1:1001 S PUEBLO BLVD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-1682
Practice Address - Country:US
Practice Address - Phone:719-564-0990
Practice Address - Fax:719-564-6817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO37001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01734237OtherJENNIFER KATTENSTELTE
CO02073807OtherJAMIE JOHNSON
CO81971842Medicaid