MEDICARE: MS. VALERY SANDRA SWEENY D.D.S.

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	122300000X	Dentist	42616	CA

General Provider Information

NPI Number	:	1477760858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VALERY SANDRA SWEENY D.D.S.

Provider Business Mailing Address
First Line	:	3706 W SUNSET BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-1528
Country	:	US
Telephone Number	:	310-441-0111
Fax Number	:	323-664-8635

Provider Business Practice Location Address
First Line	:	3706 W SUNSET BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-1528
Country	:	US
Telephone Number	:	323-669-0339
Fax Number	:	323-664-8635

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	07/08/2007

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