Provider Demographics
NPI:1043302375
Name:SWINNEY, BRADY PARKER (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRADY
Middle Name:PARKER
Last Name:SWINNEY
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 1:132 S HORACE AVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702-6159
Mailing Address - Country:US
Mailing Address - Phone:903-593-7607
Mailing Address - Fax:903-593-3965
Practice Address - Street 1:908 W DUVAL ST
Practice Address - Street 2:
Practice Address - City:TROUP
Practice Address - State:TX
Practice Address - Zip Code:75789-1718
Practice Address - Country:US
Practice Address - Phone:903-842-3998
Practice Address - Fax:903-842-3142
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX98341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice