Provider Demographics
NPI:1306029350
Name:BRYAN J. MCSWEENY JR., DMD, PC
Entity Type:Organization
Organization Name:BRYAN J. MCSWEENY JR., DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCSWEENY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-748-1380
Mailing Address - Street 1:PO BOX 982
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:MA
Mailing Address - Zip Code:02738-0018
Mailing Address - Country:US
Mailing Address - Phone:508-748-1380
Mailing Address - Fax:508-748-1380
Practice Address - Street 1:154 FRONT STREET
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:MA
Practice Address - Zip Code:02738
Practice Address - Country:US
Practice Address - Phone:508-748-1380
Practice Address - Fax:508-748-1380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA118001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty