Provider Demographics
NPI:1902994858
Name:SWEENEY, GREGG A (DDS)
Entity type:Individual
Prefix:DR
First Name:GREGG
Middle Name:A
Last Name:SWEENEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8354 LITTLE EAGLE CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46234-3818
Mailing Address - Country:US
Mailing Address - Phone:317-209-3000
Mailing Address - Fax:317-209-3003
Practice Address - Street 1:8354 LITTLE EAGLE CT
Practice Address - Street 2:SUITE A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46234-3818
Practice Address - Country:US
Practice Address - Phone:317-209-3000
Practice Address - Fax:317-209-3003
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120080401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice