Provider Demographics
NPI:1083810154
Name:SWEENEY, JAMES ANDREW (DDS)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ANDREW
Last Name:SWEENEY
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 1058
Mailing Address - Street 2:
Mailing Address - City:AVA
Mailing Address - State:MO
Mailing Address - Zip Code:65608-1058
Mailing Address - Country:US
Mailing Address - Phone:417-683-3636
Mailing Address - Fax:417-683-3681
Practice Address - Street 1:132 W WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:AVA
Practice Address - State:MO
Practice Address - Zip Code:65608-6504
Practice Address - Country:US
Practice Address - Phone:417-683-3636
Practice Address - Fax:417-683-3681
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA551901223G0001X
MO2020033656122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice