Provider Demographics
NPI:1568504140
Name:SHWEDEL, SCOTT DAVID (DDS)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:DAVID
Last Name:SHWEDEL
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 1:6150 DIAMOND CENTRE CT
Mailing Address - Street 2:BUILDING 300, SUITE 2
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4365
Mailing Address - Country:US
Mailing Address - Phone:239-243-9238
Mailing Address - Fax:239-433-5557
Practice Address - Street 1:6150 DIAMOND CENTRE CT
Practice Address - Street 2:BUILDING 300, SUITE 2
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4365
Practice Address - Country:US
Practice Address - Phone:239-243-9238
Practice Address - Fax:239-433-5557
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019441122300000X
FLDN 191111223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist