Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 578 | AK |
NPI | 1013029891 |
---|---|
Provider Name | Dr. Max W. Swenson |
First Address | Anchorage, AK 99503-2745 |
Second Address | Anchorage, AK 99503-2745 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01611666 | UNITED CONCORDIA ID # (01) | AK |