Larry Dean Swanson, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5165 Issued in NE

Practice address

427 North Broadway Street
Wahoo, NE 68066

Phone

(402) 443-4989

Fax

(402) 443-1240

NPI assigned

Nov 28, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Quadrant Dental Wahoo LLC

  • Dental Clinic/Center
  • Wahoo, NE
  • NPI 1629740030
  NPD (past)

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1235205238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "427 NORTH BROADWAY STREET",
            "city": "WAHOO",
            "state": "NE",
            "postal_code": "68066",
            "telephone_number": "402-443-4989",
            "fax_number": "402-443-1240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "427 NORTH BROADWAY STREET",
            "city": "WAHOO",
            "state": "NE",
            "postal_code": "68066",
            "telephone_number": "402-443-4989",
            "fax_number": "402-443-1240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SWANSON",
        "first_name": "LARRY",
        "middle_name": "DEAN",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NE",
            "license": "5165",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47069066500",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "05662",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael J Spicka, DPT
• Mary Rosemarie Stapert, PTA
• Rebecca Lynn Stuck
• Paul Sutton, DC
• Sydney Jo Svehla, OT
• Whitney Swanson, M.S.ED., CCC-SLP
• Cory Sylliaasen, DPT
• Connie Syverson
• Todd Tasich, DPT
• Patricia Ann Teeter, APRN

• General Practice Dentistry in Wahoo, NE
• Providers in Wahoo, NE by specialty
• General Practice Dentistry in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.