Provider Demographics
NPI:1932282357
Name:SHEEHAN, SIOBHAN MARIE (DDS MS)
Entity Type:Individual
Prefix:
First Name:SIOBHAN
Middle Name:MARIE
Last Name:SHEEHAN
Suffix:
Gender:F
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 1:1510 TREMONT STREET
Mailing Address - Street 2:
Mailing Address - City:DUXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02332
Mailing Address - Country:US
Mailing Address - Phone:781-934-5583
Mailing Address - Fax:781-934-5018
Practice Address - Street 1:1510 TREMONT STREET
Practice Address - Street 2:
Practice Address - City:DUXBURY
Practice Address - State:MA
Practice Address - Zip Code:02332
Practice Address - Country:US
Practice Address - Phone:781-934-5583
Practice Address - Fax:781-934-5018
Is Sole Proprietor?:No
Enumeration Date:2006-10-21
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA176761223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics