Provider Demographics
NPI:1063520104
Name:DRS. SWEENEY, WISE AND ROMANOW, DDS,DMD,PA
Entity type:Organization
Organization Name:DRS. SWEENEY, WISE AND ROMANOW, DDS,DMD,PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:TERRY
Authorized Official - Last Name:SWEENEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-926-2928
Mailing Address - Street 1:985 RUSSELL AVE
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-6211
Mailing Address - Country:US
Mailing Address - Phone:301-926-2928
Mailing Address - Fax:301-926-1802
Practice Address - Street 1:985 RUSSELL AVE
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-6211
Practice Address - Country:US
Practice Address - Phone:301-926-2928
Practice Address - Fax:301-926-1802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD135731223S0112X
MD108851223S0112X
MD55821223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC166205OtherPTAN
MD163463OtherPTAN
MD163463OtherPTAN
DC166205OtherPTAN