Provider Demographics
NPI:1659341329
Name:SWEENEY, DALE ROY (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:ROY
Last Name:SWEENEY
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 MILITARY STREET
Mailing Address - Street 2:BLDG. 3
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060
Mailing Address - Country:US
Mailing Address - Phone:810-985-6600
Mailing Address - Fax:810-985-6675
Practice Address - Street 1:2425 MILITARY STREET
Practice Address - Street 2:BLDG. 3
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060
Practice Address - Country:US
Practice Address - Phone:810-985-6600
Practice Address - Fax:810-985-6675
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010159051223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics