Provider Demographics
NPI:1568508661
Name:SWINDLE, ROBERT BRANTLEY (DMD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:BRANTLEY
Last Name:SWINDLE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1863 BISHOP ESTATES RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-4205
Mailing Address - Country:US
Mailing Address - Phone:904-265-1242
Mailing Address - Fax:
Practice Address - Street 1:9109 BAYMEADOWS RD
Practice Address - Street 2:SUITE 2
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-2014
Practice Address - Country:US
Practice Address - Phone:904-265-1242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN117111223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics