Provider Demographics
NPI:1497972194
Name:SWONKE, TERRANCE SEYMOUR (D D S)
Entity Type:Individual
Prefix:DR
First Name:TERRANCE
Middle Name:SEYMOUR
Last Name:SWONKE
Suffix:
Gender:M
Credentials:D D S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 RESEARCH FOREST DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-4273
Mailing Address - Country:US
Mailing Address - Phone:281-292-1900
Mailing Address - Fax:281-292-2679
Practice Address - Street 1:4200 RESEARCH FOREST DR
Practice Address - Street 2:SUITE 200
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-4273
Practice Address - Country:US
Practice Address - Phone:281-292-1900
Practice Address - Fax:281-292-2679
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX148171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice