Healthcare Provider Details

I. General information

NPI: 1104080431
Provider Name (Legal Business Name): MICHAEL AARON SWEENEY DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2008
Last Update Date: 08/05/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4111 BARBARA LOOP SE STE D2
RIO RANCHO NM
87124-1068
US

IV. Provider business mailing address

4111 BARBARA LOOP SE STE D2
RIO RANCHO NM
87124-1068
US

V. Phone/Fax

Practice location:
  • Phone: 505-892-8211
  • Fax: 505-892-6450
Mailing address:
  • Phone: 505-892-8211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number6064
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDD4240
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: