Provider Demographics
NPI:1003005547
Name:DO, SEAN PHUC (DMD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:PHUC
Last Name:DO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
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Mailing Address - Street 1:1341 S MILITARY HWY
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2513
Mailing Address - Country:US
Mailing Address - Phone:757-447-7333
Mailing Address - Fax:757-394-3394
Practice Address - Street 1:1341 S MILITARY HWY
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2513
Practice Address - Country:US
Practice Address - Phone:757-447-7333
Practice Address - Fax:757-394-3394
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2011-02-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0401411673122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist