Provider Demographics
NPI:1669672648
Name:SWINDERMAN, WILLIAM PHILLIP III (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:PHILLIP
Last Name:SWINDERMAN
Suffix:III
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 ELSIE AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-2912
Mailing Address - Country:US
Mailing Address - Phone:864-962-6671
Mailing Address - Fax:
Practice Address - Street 1:330 HARRISON BRIDGE RD
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29680-7133
Practice Address - Country:US
Practice Address - Phone:864-962-6671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30022585122300000X
SC44991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2748487Medicaid