Provider Demographics
NPI:1235887308
Name:SWINSON, HEATHER ASHLEY (DDS, MSD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:ASHLEY
Last Name:SWINSON
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16038 CAREFREE PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-2047
Mailing Address - Country:US
Mailing Address - Phone:765-432-9325
Mailing Address - Fax:
Practice Address - Street 1:16038 CAREFREE PL
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-2047
Practice Address - Country:US
Practice Address - Phone:765-432-9325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY107851223G0001X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice