Provider Demographics
NPI:1902989460
Name:SWANN, SAMUEL TODD (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:TODD
Last Name:SWANN
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:PO BOX 248
Mailing Address - Street 2:
Mailing Address - City:GREENBRIER
Mailing Address - State:AR
Mailing Address - Zip Code:72058-0248
Mailing Address - Country:US
Mailing Address - Phone:501-679-6736
Mailing Address - Fax:501-679-5967
Practice Address - Street 1:15 WILSON FARM RD
Practice Address - Street 2:
Practice Address - City:GREENBRIER
Practice Address - State:AR
Practice Address - Zip Code:72058-0248
Practice Address - Country:US
Practice Address - Phone:501-679-6736
Practice Address - Fax:501-679-5967
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR30691223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health