Organization
SWAN PEDIATRIC DENTAL
Active
Other names
Salem Smiles
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW ALLEN SWAN DDS (OWNER)
(801) 718-8348
Entity
Organization
Contact information
Practice address
601 N STATE ROAD 198, SALEM, UT 84653-4504
(801) 423-7969
Mailing address
1177 W 1960 N, PLEASANT GROVE, UT 84062-4039
(801) 718-8348
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0221X
Pediatric Dentistry
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336405315
—
UT
Enumeration date
01/06/2019
Last updated
01/06/2019
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