1013053024 NPI number — DR. ROBERT GLENDON SWARTS DDS,MS

Table of content: DR. ROBERT GLENDON SWARTS DDS,MS (NPI 1013053024)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013053024 NPI number — DR. ROBERT GLENDON SWARTS DDS,MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWARTS
Provider First Name:
ROBERT
Provider Middle Name:
GLENDON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS,MS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013053024
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 450
Provider Second Line Business Mailing Address:
450 OLD ABE ROAD
Provider Business Mailing Address City Name:
LAC DU FLAMBEAU
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54538-0450
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-588-4280
Provider Business Mailing Address Fax Number:
715-588-2269

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
W12802 COUNTY HIGHWAY A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOWLER
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-793-4144
Provider Business Practice Location Address Fax Number:
715-793-5044
Provider Enumeration Date:
01/29/2007

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:  2901011427 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 6640 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6640 . This is a "WI DENTAL LICENSE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 195816016 . This is a "BCBS MEDICAL PROVIDER NUM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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