Provider Demographics
NPI:1548751902
Name:AIKEN, SEAN ALEXANDER (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:ALEXANDER
Last Name:AIKEN
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 SAINT MATTHEWS AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3158
Mailing Address - Country:US
Mailing Address - Phone:502-895-3774
Mailing Address - Fax:502-895-3774
Practice Address - Street 1:139 SAINT MATTHEWS AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3158
Practice Address - Country:US
Practice Address - Phone:502-895-3774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-22
Last Update Date:2020-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10085122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist