Provider Demographics
NPI:1265499743
Name:SWEENEY, JOHN EDWARD (DDS)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:EDWARD
Last Name:SWEENEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:44 SOUTH ST CROIX TRAIL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAKELAND
Mailing Address - State:MN
Mailing Address - Zip Code:55043
Mailing Address - Country:US
Mailing Address - Phone:651-436-5177
Mailing Address - Fax:651-436-2421
Practice Address - Street 1:44 SOUTH ST CROIX TRAIL
Practice Address - Street 2:SUITE 100
Practice Address - City:LAKELAND
Practice Address - State:MN
Practice Address - Zip Code:55043
Practice Address - Country:US
Practice Address - Phone:651-436-5177
Practice Address - Fax:651-436-2421
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8657122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist