Provider Demographics
NPI:1215044599
Name:SWANSON, SANDRA MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:MARIE
Last Name:SWANSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 E WHITESTONE BLVD
Mailing Address - Street 2:SUITE #162
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613
Mailing Address - Country:US
Mailing Address - Phone:512-259-6633
Mailing Address - Fax:512-259-6590
Practice Address - Street 1:180 E WHITESTONE BLVD
Practice Address - Street 2:SUITE #162
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613
Practice Address - Country:US
Practice Address - Phone:512-259-6633
Practice Address - Fax:512-259-6590
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19414122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist