Provider Demographics
NPI:1528049624
Name:SWENNES, HAROLD GOODMAN III (DDS)
Entity type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:GOODMAN
Last Name:SWENNES
Suffix:III
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:PO BOX 632
Mailing Address - Street 2:
Mailing Address - City:CHISHOLM
Mailing Address - State:MN
Mailing Address - Zip Code:55719-0632
Mailing Address - Country:US
Mailing Address - Phone:218-254-3311
Mailing Address - Fax:218-254-4531
Practice Address - Street 1:217 N W 1 ST
Practice Address - Street 2:
Practice Address - City:CHISOLM
Practice Address - State:MN
Practice Address - Zip Code:55719
Practice Address - Country:US
Practice Address - Phone:218-254-3311
Practice Address - Fax:218-254-4531
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND8659122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist