Provider Demographics
NPI:1184787475
Name:WEXFORD FAMILY DENTISTRY
Entity type:Organization
Organization Name:WEXFORD FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRIMARY DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHEEDY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:724-935-3610
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:734-935-3610
Mailing Address - Fax:734-935-0566
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:734-935-3610
Practice Address - Fax:734-935-0566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS 022952 L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty