Provider Demographics
NPI:1659580611
Name:NICKENS, SEAN D (DMD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:D
Last Name:NICKENS
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 1:620 PAXTON PL
Mailing Address - Street 2:STE 104
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-8279
Mailing Address - Country:US
Mailing Address - Phone:717-569-7645
Mailing Address - Fax:717-569-7650
Practice Address - Street 1:620 PAXTON PL
Practice Address - Street 2:STE 104
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-8279
Practice Address - Country:US
Practice Address - Phone:717-569-7645
Practice Address - Fax:717-569-7650
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2009-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0358541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice