Provider Demographics
NPI:1063801926
Name:DRS. SWEENEY, WISE AND ROMANOW, DDS, DMD, PA
Entity type:Organization
Organization Name:DRS. SWEENEY, WISE AND ROMANOW, DDS, DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:A. TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SWEENEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-926-2928
Mailing Address - Street 1:985 RUSSELL AVE
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-6211
Mailing Address - Country:US
Mailing Address - Phone:301-926-2928
Mailing Address - Fax:301-926-1802
Practice Address - Street 1:985 RUSSELL AVE
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-6211
Practice Address - Country:US
Practice Address - Phone:301-926-2928
Practice Address - Fax:301-926-1802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD55821223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1063520104OtherNPI