Provider Demographics
NPI:1720601487
Name:CHECHANG, SEAN P (DMD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:P
Last Name:CHECHANG
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 1:1600 S 4TH AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-3401
Mailing Address - Country:US
Mailing Address - Phone:309-263-2781
Mailing Address - Fax:
Practice Address - Street 1:134 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550-1532
Practice Address - Country:US
Practice Address - Phone:309-263-7449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-28
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0326091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice