Provider Demographics
NPI:1548210073
Name:HAMILTON, SEAN MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:MICHAEL
Last Name:HAMILTON
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 1:1506 WAYNE MEMORIAL DR STE A
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-2202
Mailing Address - Country:US
Mailing Address - Phone:919-731-4447
Mailing Address - Fax:919-731-4381
Practice Address - Street 1:1506 WAYNE MEMORIAL DR STE A
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-2202
Practice Address - Country:US
Practice Address - Phone:919-731-4447
Practice Address - Fax:919-731-4381
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC66741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8990108Medicaid