Healthcare Provider Details

I. General information

NPI: 1316032022
Provider Name (Legal Business Name): WILLIAM SWILLEY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12335 HYMEADOW DR SUITE 250
AUSTIN TX
78750-1934
US

IV. Provider business mailing address

807 W PEACH HOLLOW CIR
PEARLAND TX
77584-4005
US

V. Phone/Fax

Practice location:
  • Phone: 512-250-5012
  • Fax: 512-219-8510
Mailing address:
  • Phone: 713-436-9418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number9391
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: