Marvin Allen Swan, DDS
Individual provider Active NPI Dentist · Grant, NE
NPI 1508969189 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1508969189
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 4779 (NE)
- Practice address
- 242 Central Ave
Grant, NE 69140-0863 - Phone
- (308) 352-4241
- Fax
- (308) 352-4113
- NPI assigned
- Sep 7, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4779 | NE | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 4779 | NE | Yes |
Addresses
Primary practice location
242 Central Ave
Grant, NE 69140-0863
Mailing address
PO Box 863
Grant, NE 69140-0863
Phone (308) 352-4241
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 47061400900 | Medicaid | NE |
Other providers in Grant, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.