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General NPI Number Information
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NPI Number | 1174072888
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Entity Type | Organization
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Legal Business Name | SHEEHY DENTAL LLC
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Dates
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Enumeration Date | 09/23/2016
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Last Update Date | 09/23/2016
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Provider Practice Location Address
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Address Line | 810 W DR MARTIN LUTHER KING JR BLVD STE 2900
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City | SEFFNER
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State | FL
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Zip | 33584-4583
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Country | US
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Telephone | 813-330-2006
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Fax | 813-438-4928
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Provider Business Mailing Address
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Address Line | 810 W DR MARTIN LUTHER KING JR BLVD STE 2900
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City | SEFFNER
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State | FL
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Zip | 33584-4583
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Country | US
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Telephone | 813-330-2006
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Fax | 813-438-4928
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | DR. OMARI SHEEHY
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Credential | DDS
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Telephone | 813-330-2006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN 20388
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License Number State | FL
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