Provider Demographics
NPI:1194940676
Name:REID R SWENSON, D.D.S, M.S
Entity type:Organization
Organization Name:REID R SWENSON, D.D.S, M.S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REID
Authorized Official - Middle Name:R
Authorized Official - Last Name:SWENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:801-766-5500
Mailing Address - Street 1:680 E MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-2241
Mailing Address - Country:US
Mailing Address - Phone:801-766-5500
Mailing Address - Fax:801-766-5606
Practice Address - Street 1:680 E MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2241
Practice Address - Country:US
Practice Address - Phone:801-766-5500
Practice Address - Fax:801-766-5606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT368918-99211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty