Provider Demographics
NPI:1821055849
Name:SHEEDY, MARK D (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:SHEEDY
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 1:1000 BROOKTREE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9286
Mailing Address - Country:US
Mailing Address - Phone:724-935-3610
Mailing Address - Fax:724-935-0566
Practice Address - Street 1:1000 BROOKTREE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9286
Practice Address - Country:US
Practice Address - Phone:724-935-3610
Practice Address - Fax:734-935-0566
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS 022952 L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice