Provider Demographics
NPI:1659382927
Name:SWEDENBURG, WILLIAM KELLY (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:KELLY
Last Name:SWEDENBURG
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 1:716 ASHLEY PL
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-3729
Mailing Address - Country:US
Mailing Address - Phone:972-517-6453
Mailing Address - Fax:
Practice Address - Street 1:5501 INDEPENDENCE PKWY
Practice Address - Street 2:SUITE 205
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-5463
Practice Address - Country:US
Practice Address - Phone:972-517-6453
Practice Address - Fax:972-943-5720
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX144411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice