Provider Demographics
NPI:1194869784
Name:SWISHER, LARRY GENE (DDS)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:GENE
Last Name:SWISHER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 N GRANT ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-1355
Mailing Address - Country:US
Mailing Address - Phone:509-783-1384
Mailing Address - Fax:509-783-7969
Practice Address - Street 1:1310 N GRANT ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-1355
Practice Address - Country:US
Practice Address - Phone:509-783-1384
Practice Address - Fax:509-783-7969
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1223G0001X1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADE00004709OtherDENTAL LICENSE
WA5395405Medicaid