Provider Demographics
NPI:1669442489
Name:MCDONNELL, SEAN THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:THOMAS
Last Name:MCDONNELL
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 1:323 DESOTO DR
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32169-5208
Mailing Address - Country:US
Mailing Address - Phone:386-871-1702
Mailing Address - Fax:
Practice Address - Street 1:1440 REED CANAL RD
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-9418
Practice Address - Country:US
Practice Address - Phone:386-760-0550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN167831223P0221X
VA04014107031223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry