Provider Demographics
NPI:1164571063
Name:TIMOTHY J. SWEENEY
Entity Type:Organization
Organization Name:TIMOTHY J. SWEENEY
Other - Org Name:DBA OLNEY FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SWEENEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:940-564-4470
Mailing Address - Street 1:125 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:TX
Mailing Address - Zip Code:76374
Mailing Address - Country:US
Mailing Address - Phone:940-564-4470
Mailing Address - Fax:940-564-4472
Practice Address - Street 1:125 E MAIN ST
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:TX
Practice Address - Zip Code:76374
Practice Address - Country:US
Practice Address - Phone:940-564-4470
Practice Address - Fax:940-564-4472
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TIMOTHY J. SWEENEY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-09
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153191501Medicaid