Provider Demographics
NPI:1760432611
Name:HART, SEAN P (DDS, MSD, PC)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:P
Last Name:HART
Suffix:
Gender:M
Credentials:DDS, MSD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1533 KOSSUTH ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-1560
Mailing Address - Country:US
Mailing Address - Phone:765-742-8792
Mailing Address - Fax:765-742-8792
Practice Address - Street 1:1533 KOSSUTH ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-1560
Practice Address - Country:US
Practice Address - Phone:765-742-8792
Practice Address - Fax:765-742-8792
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010263A1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics