Provider Demographics
NPI:1609904549
Name:SWANSON, RICHARD C (DDS)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:C
Last Name:SWANSON
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:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34423-0068
Mailing Address - Country:US
Mailing Address - Phone:352-795-1223
Mailing Address - Fax:352-795-1637
Practice Address - Street 1:1815 SOUTH EAST US HWY 19
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34423
Practice Address - Country:US
Practice Address - Phone:352-795-1223
Practice Address - Fax:352-795-1637
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0010985122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist