Matthew Timothy Swanson, D.D.S

Primary specialty

DentistTaxonomy code 122300000X

License

D12389 Issued in MN

Practice address

307 Boatner Rd
Suite 114
Eglin Afb, FL 32542-1391

Phone

(850) 883-8782

NPI assigned

Aug 8, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 2, 2024 through Jan 2, 2028

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Oral & Maxillofacial Surgery Fox Cities, S.C.

  • Durable Medical Equipment & Medical Supplies
  • Appleton, WI
  • NPI 1154555373
  NPD (past)
• Teton Oral and Maxillofacial Surgery

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Jackson, WY
  • NPI 1740776202
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1186531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1186531200000",
    "number": "1083805501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 BOATNER RD",
            "address_2": "SUITE 114",
            "city": "EGLIN AFB",
            "state": "FL",
            "postal_code": "325421391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 BOATNER RD",
            "address_2": "SUITE 114",
            "city": "EGLIN AFB",
            "state": "FL",
            "postal_code": "325421391",
            "telephone_number": "850-883-8782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SWANSON",
        "first_name": "MATTHEW",
        "middle_name": "TIMOTHY",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-08-08",
        "last_updated": "2007-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D12389",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathleen Marie Styron, RN
• John-Paul Suastegui, DO
• Michael Reid Suhler, DDS
• Sunland Optical Co., Inc.
• Helena M Swank, DDS
• Gregory Swets, DO, DC
• Sofia Maria Szari, M.D.
• Julianne Marie Talbott, APRN, CRNA
• Jason Paul Tausek, LCSW
• Boyce A Taylor

• Dentist in Eglin Afb, FL
• Providers in Eglin Afb, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.