1457427189 NPI number — LAWRENCE DEAN SWENSON DDS

Table of content: LAWRENCE DEAN SWENSON DDS (NPI 1457427189)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457427189 NPI number — LAWRENCE DEAN SWENSON DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWENSON
Provider First Name:
LAWRENCE
Provider Middle Name:
DEAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SWENSON
Provider Other First Name:
LARRY
Provider Other Middle Name:
DEAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1457427189
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 70
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANSON
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50563
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-469-3000
Provider Business Mailing Address Fax Number:
712-469-2552

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1303 11TH AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANSON
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-469-3000
Provider Business Practice Location Address Fax Number:
712-469-2552
Provider Enumeration Date:
11/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  6075 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223G0001X , with the licence number: DE00006576 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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