MEDICARE: TIMOTHY W. SHEEHAN,LTD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	019-017669	IL

General Provider Information

NPI Number	:	1336316827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIMOTHY W. SHEEHAN,LTD.

Provider Business Mailing Address
First Line	:	525 TYLER RD
Second Line	:	SUITE K
City	:	ST CHARLES
State	:	IL
Zip	:	60174-3305
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	525 TYLER RD
Second Line	:
City	:	ST CHARLES
State	:	IL
Zip	:	60174-3305
Country	:	US
Telephone Number	:	630-584-8444
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TIMOTHY SHEEHAN
Credential	:	D.D.S.
Telephone Number	:	630-584-8444

Provider Enumeration Date	:	05/13/2008
Last Update Date	:	05/13/2008

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