Provider Demographics
NPI:1952857211
Name:PIERCE, SEAN (DDS)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:PIERCE
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 1:1658 CAMDEN AVE
Mailing Address - Street 2:UNIT 105
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-7548
Mailing Address - Country:US
Mailing Address - Phone:920-517-3928
Mailing Address - Fax:
Practice Address - Street 1:1658 CAMDEN AVE
Practice Address - Street 2:UNIT 105
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-7548
Practice Address - Country:US
Practice Address - Phone:920-517-3928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program