Provider Demographics
NPI:1033236559
Name:OBRIEN, SEAN ROBERT (DDS)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:ROBERT
Last Name:OBRIEN
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 1:1716 S LILLEY RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-1108
Mailing Address - Country:US
Mailing Address - Phone:734-397-5500
Mailing Address - Fax:734-394-2528
Practice Address - Street 1:1716 S LILLEY RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-1108
Practice Address - Country:US
Practice Address - Phone:734-397-5500
Practice Address - Fax:734-394-2528
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0137121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice