Provider Demographics
NPI:1174072888
Name:SHEEHY DENTAL LLC
Entity type:Organization
Organization Name:SHEEHY DENTAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OMARI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEEHY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:813-330-2006
Mailing Address - Street 1:810 W DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:STE 2900
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33584-4583
Mailing Address - Country:US
Mailing Address - Phone:813-330-2006
Mailing Address - Fax:813-438-4928
Practice Address - Street 1:810 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:STE 2900
Practice Address - City:SEFFNER
Practice Address - State:FL
Practice Address - Zip Code:33584-4583
Practice Address - Country:US
Practice Address - Phone:813-330-2006
Practice Address - Fax:813-438-4928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 20388122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty