Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 11819 | MN |
N | 1223S0112X | Oral and Maxillofacial Surgeon | D9087 | OR |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 50992 | MN |
N | 204E00000X | Oral & Maxillofacial Surgeon | MD29162 | OR |
NPI | 1356320576 |
---|---|
Provider Name | David C Swiderski |
First Address | Salem, OR 97302-4345 |
Second Address | Salem, OR 97302-4345 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2006 |
Last Update Date | 18/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
729449200 | (05) | MN |
P00052037 | MEDICARE, RAILROAD (01) | MN |
U96525 | (02) |