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General NPI Number Information
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NPI Number | 1295198935
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Entity Type | Organization
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Legal Business Name | SHEEHY SLEEP DENTAL
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Dates
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Enumeration Date | 03/31/2016
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Last Update Date | 03/31/2016
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Provider Practice Location Address
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Address Line | 1120 E TWIGGS ST UNIT 391
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City | TAMPA
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State | FL
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Zip | 33602-3155
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Country | US
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Telephone | 678-778-3477
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Fax |
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Provider Business Mailing Address
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Address Line | 810 W DR. MARTIN LUTHER KING JR. BLVD SUITE #2900
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City | SEFFNER
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State | FL
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Zip | 33584
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Country | US
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Telephone | 678-778-3477
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. OMARI KAMAL SHEEHY
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Credential | DDS
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Telephone | 678-778-3477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DN20388
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License Number State | FL
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