Provider Demographics
NPI:1053483214
Name:SWEENEY, PATRICK F (DDS)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:F
Last Name:SWEENEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 IOWA AVE
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN DELLS
Mailing Address - State:WI
Mailing Address - Zip Code:53965-1839
Mailing Address - Country:US
Mailing Address - Phone:608-253-4701
Mailing Address - Fax:608-254-2245
Practice Address - Street 1:910 IOWA AVE
Practice Address - Street 2:
Practice Address - City:WISCONSIN DELLS
Practice Address - State:WI
Practice Address - Zip Code:53965-1839
Practice Address - Country:US
Practice Address - Phone:608-253-4701
Practice Address - Fax:608-254-2245
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5001363-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38377200Medicaid