Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 2901021795 | MI |
NPI | 1053726422 |
---|---|
Provider Name | Kathryn Lynn Swanson |
First Address | Grand Rapids, MI 49546-3825 |
Second Address | Hudsonville, MI 49426-1439 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2014 |
Last Update Date | 29/11/2018 |