Provider Demographics
NPI:1275641086
Name:SHEEDY, EUGENE JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:JOHN
Last Name:SHEEDY
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 1:701 W UNION BLVD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018
Mailing Address - Country:US
Mailing Address - Phone:610-868-0833
Mailing Address - Fax:610-868-1598
Practice Address - Street 1:701 W UNION BLVD
Practice Address - Street 2:SUITE 7
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018
Practice Address - Country:US
Practice Address - Phone:610-868-0833
Practice Address - Fax:610-868-1598
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS02081061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA112147OtherCONCORDIA