Provider Demographics
NPI:1043472707
Name:SWISHER, BRENDON MILES (DDS)
Entity Type:Individual
Prefix:
First Name:BRENDON
Middle Name:MILES
Last Name:SWISHER
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 1:412 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74003-3603
Mailing Address - Country:US
Mailing Address - Phone:918-336-1262
Mailing Address - Fax:
Practice Address - Street 1:412 E 4TH ST
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003-3603
Practice Address - Country:US
Practice Address - Phone:918-336-1262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK60421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice