Provider Demographics
NPI:1467542514
Name:SHEEHAN, LARRY E (DMD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:E
Last Name:SHEEHAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29440-3964
Mailing Address - Country:US
Mailing Address - Phone:843-546-8416
Mailing Address - Fax:843-546-8417
Practice Address - Street 1:804 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-3964
Practice Address - Country:US
Practice Address - Phone:843-546-8416
Practice Address - Fax:843-546-8417
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ-1768-8Medicaid