1891917266 NPI number — DR. PATRICK F SWEENEY III D.M.D.

Table of content: DR. PATRICK F SWEENEY III D.M.D. (NPI 1891917266)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891917266 NPI number — DR. PATRICK F SWEENEY III D.M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWEENEY
Provider First Name:
PATRICK
Provider Middle Name:
F
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
D.M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891917266
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1700 SHALLCROSS AVE STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19806-2344
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-658-7200
Provider Business Mailing Address Fax Number:
302-658-7500

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 SHALLCROSS AVE STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19806-2344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-658-7200
Provider Business Practice Location Address Fax Number:
302-658-7500
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  1057 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 202289843 . This is a "DELTA DENTAL" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 65978 . This is a "MET LIFE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 2753 . This is a "DOMINION" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 513299 . This is a "AETNA" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 102485 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 023666 . This is a "DELTA" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




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