Healthcare Provider Details

I. General information

NPI: 1760465306
Provider Name (Legal Business Name): THOMAS PATRICK SWEENEY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 06/24/2020
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 5TH AVE STE 4660
SEATTLE WA
98104-7057
US

IV. Provider business mailing address

701 5TH AVE STE 4660
SEATTLE WA
98104-7057
US

V. Phone/Fax

Practice location:
  • Phone: 206-682-8200
  • Fax: 206-386-5099
Mailing address:
  • Phone: 206-682-8200
  • Fax: 425-637-8704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number5965
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: