Provider Demographics
NPI:1487974408
Name:SWIGERT, RYAN CHARLES (DDS)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:CHARLES
Last Name:SWIGERT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1467 PALMA RD STE 1
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-6785
Mailing Address - Country:US
Mailing Address - Phone:928-763-1203
Mailing Address - Fax:928-758-1072
Practice Address - Street 1:1467 PALMA RD STE 1
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-6785
Practice Address - Country:US
Practice Address - Phone:928-763-1203
Practice Address - Fax:928-758-1072
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0089561223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery