Provider Demographics
NPI:1780024547
Name:SHEAHAN, BRANDON S (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:S
Last Name:SHEAHAN
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:PO BOX 1606
Mailing Address - Street 2:
Mailing Address - City:EAST HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59635-1606
Mailing Address - Country:US
Mailing Address - Phone:406-227-5886
Mailing Address - Fax:406-227-3722
Practice Address - Street 1:6 W MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST HELENA
Practice Address - State:MT
Practice Address - Zip Code:59635-9011
Practice Address - Country:US
Practice Address - Phone:406-227-5886
Practice Address - Fax:406-227-3722
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-26
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-4489122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist