Provider Demographics
NPI:1669494738
Name:SWILLING, THOMAS JEFFERY (DDS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JEFFERY
Last Name:SWILLING
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 1:107 E 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-4317
Mailing Address - Country:US
Mailing Address - Phone:704-864-0359
Mailing Address - Fax:704-864-8701
Practice Address - Street 1:107 E 3RD AVE
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-4317
Practice Address - Country:US
Practice Address - Phone:704-864-0359
Practice Address - Fax:704-864-8701
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC45411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8998231Medicaid