Provider Demographics
NPI:1952430654
Name:SWEENEY, SHERESE TONETTE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHERESE
Middle Name:TONETTE
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2761
Mailing Address - Country:US
Mailing Address - Phone:631-598-2940
Mailing Address - Fax:
Practice Address - Street 1:193 BROADWAY
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2761
Practice Address - Country:US
Practice Address - Phone:631-598-2940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0468081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice