Provider Demographics
NPI:1942587100
Name:SEBASTIAN, NEVIN THOMAS (DDS)
Entity Type:Individual
Prefix:
First Name:NEVIN
Middle Name:THOMAS
Last Name:SEBASTIAN
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 1:2860 MICHELLE FL 2
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-1008
Mailing Address - Country:US
Mailing Address - Phone:714-368-2077
Mailing Address - Fax:714-368-2092
Practice Address - Street 1:10000 COMMONS ST
Practice Address - Street 2:
Practice Address - City:LONETREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5501
Practice Address - Country:US
Practice Address - Phone:303-790-8080
Practice Address - Fax:390-790-0679
Is Sole Proprietor?:No
Enumeration Date:2011-11-15
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO105661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice