Provider Demographics
NPI:1316956410
Name:SWAN, ASHLEY B (DMD)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:B
Last Name:SWAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:B
Other - Last Name:ANGARAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:400 SW BOND ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3798
Mailing Address - Country:US
Mailing Address - Phone:541-389-3073
Mailing Address - Fax:541-389-9652
Practice Address - Street 1:400 SW BOND ST STE 100
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3798
Practice Address - Country:US
Practice Address - Phone:541-389-3073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD102571223P0221X
NV48611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100507613Medicaid
OR500689928Medicaid