Provider Demographics
NPI:1205862646
Name:COUCH, SEAN M (DDS)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:M
Last Name:COUCH
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 1:25985 BARBER CUT OFF RD NE STE B2
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:WA
Mailing Address - Zip Code:98346-9596
Mailing Address - Country:US
Mailing Address - Phone:206-419-7223
Mailing Address - Fax:
Practice Address - Street 1:25985 BARBER CUT OFF RD NE STE B2
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:WA
Practice Address - Zip Code:98346-9596
Practice Address - Country:US
Practice Address - Phone:503-249-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD87031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice