Provider Demographics
NPI:1720309396
Name:SHEEHY, ROGER EDWARD (ROGER SHEEHY DMD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:EDWARD
Last Name:SHEEHY
Suffix:
Gender:M
Credentials:ROGER SHEEHY DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3341B PARK AVE
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-3716
Mailing Address - Country:US
Mailing Address - Phone:516-826-3336
Mailing Address - Fax:516-826-3353
Practice Address - Street 1:3341B PARK AVE
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-3716
Practice Address - Country:US
Practice Address - Phone:516-826-3336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY318891223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics