Provider Demographics
NPI:1497856850
Name:MORAN, SEAN CONNOR (DDS)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:CONNOR
Last Name:MORAN
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 1:415 SANSOME ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-3120
Mailing Address - Country:US
Mailing Address - Phone:415-433-9032
Mailing Address - Fax:415-433-6220
Practice Address - Street 1:415 SANSOME ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-3120
Practice Address - Country:US
Practice Address - Phone:415-433-9032
Practice Address - Fax:415-433-6220
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA369871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice