Provider Demographics
NPI:1821673468
Name:PAIRAWAN, SEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:
Last Name:PAIRAWAN
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 1:21750 VALLEY BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:CITY OF INDUSTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91789-0939
Mailing Address - Country:US
Mailing Address - Phone:909-595-0807
Mailing Address - Fax:
Practice Address - Street 1:21750 VALLEY BLVD STE C
Practice Address - Street 2:
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91789-0939
Practice Address - Country:US
Practice Address - Phone:909-595-0807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61298996122300000X
CADDS108742122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist