Provider Demographics
NPI:1942359278
Name:SWENSON, RALPH DALE (DDS)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:DALE
Last Name:SWENSON
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 1:2036 BURNETT DRIVE
Mailing Address - Street 2:
Mailing Address - City:MORA
Mailing Address - State:MN
Mailing Address - Zip Code:55051
Mailing Address - Country:US
Mailing Address - Phone:320-679-1961
Mailing Address - Fax:
Practice Address - Street 1:620 S UNION
Practice Address - Street 2:
Practice Address - City:MORA
Practice Address - State:MN
Practice Address - Zip Code:55051
Practice Address - Country:US
Practice Address - Phone:320-679-3073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6908122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist