Provider Demographics
NPI:1083901425
Name:PACK, SEAN E (DDS MD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:E
Last Name:PACK
Suffix:
Gender:M
Credentials:DDS MD
Other - Prefix:
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Mailing Address - Street 1:325 W LAKE LANSING RD
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-8524
Mailing Address - Country:US
Mailing Address - Phone:517-337-9759
Mailing Address - Fax:517-337-8156
Practice Address - Street 1:325 W LAKE LANSING RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-8524
Practice Address - Country:US
Practice Address - Phone:517-337-9759
Practice Address - Fax:517-337-8156
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2022-12-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI29010220381223S0112X
VA04014155961223S0112X
VA0438000372204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery