Provider Demographics
NPI:1467619338
Name:SEAN E. PATRICK, DDS, PA
Entity Type:Organization
Organization Name:SEAN E. PATRICK, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-845-9399
Mailing Address - Street 1:2522 PLANTATION CENTER DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-5298
Mailing Address - Country:US
Mailing Address - Phone:704-845-9399
Mailing Address - Fax:
Practice Address - Street 1:2522 PLANTATION CENTER DR
Practice Address - Street 2:SUITE A
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5298
Practice Address - Country:US
Practice Address - Phone:704-845-9399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7164122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty