Individual provider Active NPI

Mark Philip Swensen, DDS

  • General Practice Dentistry
  • Corvallis, OR
National Provider Identifier
1740582477
Registry record updated Dec 1, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D9063 Issued in OR
Practice address
2222 NW Lincoln Ave
Corvallis, OR 97330-2503
Phone
(541) 754-4017
NPI assigned
Dec 1, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X D9063 OR Primary

Addresses

Primary practice location

2222 NW Lincoln Ave
Corvallis, OR 97330-2503

Mailing address

2222 NW Lincoln Ave
Corvallis, OR 97330-2503
Phone (541) 754-4017

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160830000113 OR Order and Referring Only - DentistPractitioner - Dentist 6406035377

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1291161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1291161600000",
    "number": "1740582477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2222 NW LINCOLN AVE",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973302503",
            "telephone_number": "541-754-4017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2222 NW LINCOLN AVE",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973302503",
            "telephone_number": "541-754-4017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SWENSEN",
        "first_name": "MARK",
        "middle_name": "PHILIP",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-12-01",
        "last_updated": "2010-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D9063",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Corvallis, OR

Sources for this page

Verify at the official NPI Registry.