Provider Demographics
NPI:1912108556
Name:ROBERT L SWENSON DDS PC
Entity type:Organization
Organization Name:ROBERT L SWENSON DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:SWENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-853-3264
Mailing Address - Street 1:107 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MILLER
Mailing Address - State:SD
Mailing Address - Zip Code:57362-1324
Mailing Address - Country:US
Mailing Address - Phone:605-853-3264
Mailing Address - Fax:605-853-2330
Practice Address - Street 1:107 W 3RD ST
Practice Address - Street 2:
Practice Address - City:MILLER
Practice Address - State:SD
Practice Address - Zip Code:57362-1324
Practice Address - Country:US
Practice Address - Phone:605-853-3264
Practice Address - Fax:605-853-2330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM657122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7804590Medicaid