Provider Demographics
NPI:1639553456
Name:JAMES A. SWEENEY, D.D.S., INC.
Entity Type:Organization
Organization Name:JAMES A. SWEENEY, D.D.S., INC.
Other - Org Name:CLEAN SMILE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-942-1181
Mailing Address - Street 1:1669 W AVENUE J
Mailing Address - Street 2:SUITE #305
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-2866
Mailing Address - Country:US
Mailing Address - Phone:661-942-1181
Mailing Address - Fax:
Practice Address - Street 1:1669 W AVENUE J
Practice Address - Street 2:SUITE #305
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2866
Practice Address - Country:US
Practice Address - Phone:661-942-1181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty