Provider Demographics
NPI:1366551103
Name:O'SHEA, MICHAEL J (DDS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:O'SHEA
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 1:3701 S GEORGE MASON DR
Mailing Address - Street 2:SUITE C7N
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22041-3758
Mailing Address - Country:US
Mailing Address - Phone:703-998-8826
Mailing Address - Fax:703-998-8828
Practice Address - Street 1:3701 S GEORGE MASON DR
Practice Address - Street 2:SUITE C7N
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-3758
Practice Address - Country:US
Practice Address - Phone:703-998-8826
Practice Address - Fax:703-998-8828
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA040110066581223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA541451930OtherTIN