Provider Demographics
NPI:1790349777
Name:SHEEHAN, JACLYN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:
Last Name:SHEEHAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 MARIANNA RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-2094
Mailing Address - Country:US
Mailing Address - Phone:603-401-7349
Mailing Address - Fax:
Practice Address - Street 1:380 MERRIMACK ST STE 3E
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-5871
Practice Address - Country:US
Practice Address - Phone:978-685-2511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-25
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MADN18582801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program