Provider Demographics
NPI:1992808588
Name:SWANSON, THEKLA KIRSCHBAUM (DDS)
Entity type:Individual
Prefix:DR
First Name:THEKLA
Middle Name:KIRSCHBAUM
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 1:7373 FRANCE AVE SO
Mailing Address - Street 2:SUITE 402
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4598
Mailing Address - Country:US
Mailing Address - Phone:952-831-4400
Mailing Address - Fax:952-893-3041
Practice Address - Street 1:7373 FRANCE AVE SO
Practice Address - Street 2:SUITE 402
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4598
Practice Address - Country:US
Practice Address - Phone:952-831-4400
Practice Address - Fax:952-893-3041
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119411223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry