1063364644 NPI number — TYLER DENTURES AND DENTAL IMPLANTS

Table of content: DONAVAN BRETT SWINDALL MA (NPI 1124652573)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063364644 NPI number — TYLER DENTURES AND DENTAL IMPLANTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TYLER DENTURES AND DENTAL IMPLANTS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063364644
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
444 FOREST SQ STE E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONGVIEW
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75605-4463
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3864 STATE HIGHWAY 64 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TYLER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75704-6924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-508-5750
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/13/2026

Additional Information

Authorized Official

Authorized Official Last Name:
RODAWAY
Authorized Official First Name:
CINTIA
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
903-508-5750

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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