Healthcare Provider Details

I. General information

NPI: 1992800064
Provider Name (Legal Business Name): TIMOTHY J. SHEEHAN D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 09/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 INDIAN HILLS DRIVE SUITE 250
OMAHA NE
68114-4033
US

IV. Provider business mailing address

8901 INDIAN HILLS DRIVE SUITE 250
OMAHA NE
68114-4033
US

V. Phone/Fax

Practice location:
  • Phone: 402-558-0035
  • Fax: 402-558-0036
Mailing address:
  • Phone: 402-558-0035
  • Fax: 402-558-0036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number5813
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: