Healthcare Provider Details

I. General information

NPI: 1003687443
Provider Name (Legal Business Name): SWDG OF ABILENE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 01/15/2024
Certification Date: 01/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 ANTILLEY RD
ABILENE TX
79606-5100
US

IV. Provider business mailing address

2109 COMMERCE ST STE 200
DALLAS TX
75201-4350
US

V. Phone/Fax

Practice location:
  • Phone: 325-244-2434
  • Fax:
Mailing address:
  • Phone: 972-248-1221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM R JENNINGS
Title or Position: OWNER
Credential: DDS
Phone: 940-206-8956