Provider Demographics
NPI:1104080431
Name:SWEENEY, MICHAEL AARON (DMD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:AARON
Last Name:SWEENEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 BARBARA LOOP SE STE D2
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1068
Mailing Address - Country:US
Mailing Address - Phone:505-892-8211
Mailing Address - Fax:
Practice Address - Street 1:4111 BARBARA LOOP SE STE D2
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1068
Practice Address - Country:US
Practice Address - Phone:505-892-8211
Practice Address - Fax:505-892-6450
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6064122300000X
NMDD4240122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist