Healthcare Provider Details

I. General information

NPI: 1083810154
Provider Name (Legal Business Name): JAMES ANDREW SWEENEY D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 W WASHINGTON AVE
AVA MO
65608-6504
US

IV. Provider business mailing address

PO BOX 1058
AVA MO
65608-1058
US

V. Phone/Fax

Practice location:
  • Phone: 417-683-3636
  • Fax: 417-683-3681
Mailing address:
  • Phone: 417-683-3636
  • Fax: 417-683-3681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2020033656
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number55190
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: