Provider Demographics
NPI:1023224227
Name:SEAN ANDERSON, D.D.S., INC.
Entity Type:Organization
Organization Name:SEAN ANDERSON, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:925-837-4486
Mailing Address - Street 1:1501 BOLLINGER CANYON RD
Mailing Address - Street 2:STE. G
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1758
Mailing Address - Country:US
Mailing Address - Phone:925-837-4486
Mailing Address - Fax:925-837-8164
Practice Address - Street 1:1501 BOLLINGER CANYON RD
Practice Address - Street 2:STE. G
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1758
Practice Address - Country:US
Practice Address - Phone:925-837-4486
Practice Address - Fax:925-837-8164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42519122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty