Provider Demographics
NPI:1336287952
Name:WILLCUTTS, SEAN TIMOTHY (DMD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:TIMOTHY
Last Name:WILLCUTTS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 ISLAND POND RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHWICK
Mailing Address - State:MA
Mailing Address - Zip Code:01077-9591
Mailing Address - Country:US
Mailing Address - Phone:617-308-1093
Mailing Address - Fax:
Practice Address - Street 1:276 HAZARD AVE
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4643
Practice Address - Country:US
Practice Address - Phone:860-749-4245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009466122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist