Provider Demographics
NPI:1821214727
Name:SHEEHY, JOSEPH CLARENCE
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:CLARENCE
Last Name:SHEEHY
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:JOSEPH
Other - Middle Name:CLARENCE
Other - Last Name:SHEEHY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:341 N SAN MATEO DR
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2513
Mailing Address - Country:US
Mailing Address - Phone:650-342-2777
Mailing Address - Fax:650-342-6835
Practice Address - Street 1:341 N SAN MATEO DR
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2513
Practice Address - Country:US
Practice Address - Phone:650-342-2777
Practice Address - Fax:650-342-6835
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA291021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice