Provider Demographics
NPI:1073784609
Name:SWART, STEPHEN DANIEL (DOM)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:DANIEL
Last Name:SWART
Suffix:
Gender:M
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2735 LA BAJADA
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5332
Mailing Address - Country:US
Mailing Address - Phone:505-424-9527
Mailing Address - Fax:
Practice Address - Street 1:826 CAMINO DE MONTE REY
Practice Address - Street 2:SUITE B-2
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-3977
Practice Address - Country:US
Practice Address - Phone:505-424-9527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM248171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist