Individual
LARRY DEAN SWANSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
427 NORTH BROADWAY STREET, WAHOO, NE 68066
(402) 443-4989
(402) 443-1240
Mailing address
427 NORTH BROADWAY STREET, WAHOO, NE 68066
(402) 443-4989
(402) 443-1240
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5165
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05662
BLUE CROSS BLUE SHIELD
NE
05
—
47069066500
—
NE
Enumeration date
11/28/2006
Last updated
07/08/2007
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