Provider Demographics
NPI:1285672717
Name:DRS SWANN & TALLENT, PA
Entity type:Organization
Organization Name:DRS SWANN & TALLENT, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:SWANN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:704-541-3603
Mailing Address - Street 1:3111 SPRINGBANK LANE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226
Mailing Address - Country:US
Mailing Address - Phone:704-541-3603
Mailing Address - Fax:704-541-3619
Practice Address - Street 1:3111 SPRINGBANK LANE
Practice Address - Street 2:SUITE A
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226
Practice Address - Country:US
Practice Address - Phone:704-541-3603
Practice Address - Fax:704-541-3619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223S0112X
NC3793204E00000X
NC5881204E00000X
NC5962204E00000X
NC9535204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0607286OtherAETNA
01083OtherBCBS
NC8901083Medicaid
0607286OtherAETNA