Provider Demographics
NPI:1891819652
Name:SEBASTIAN, MICHAEL HARLEY (DMD, MSD, PC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:HARLEY
Last Name:SEBASTIAN
Suffix:
Gender:M
Credentials:DMD, MSD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 W WIEUCA RD NE
Mailing Address - Street 2:SUITE-300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-3248
Mailing Address - Country:US
Mailing Address - Phone:404-303-7400
Mailing Address - Fax:404-303-1555
Practice Address - Street 1:91 W WIEUCA RD NE
Practice Address - Street 2:SUITE-300
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-3248
Practice Address - Country:US
Practice Address - Phone:404-303-7400
Practice Address - Fax:404-303-1555
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010721223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics