Provider Demographics
NPI:1184717241
Name:ALEXANDER, SEAN (DMD)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:
Credentials:DMD
Other - Prefix:DR
Other - First Name:SEAN
Other - Middle Name:
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD PC
Mailing Address - Street 1:130 UNION ST
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-2918
Mailing Address - Country:US
Mailing Address - Phone:678-877-5438
Mailing Address - Fax:
Practice Address - Street 1:130 UNION ST
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-2918
Practice Address - Country:US
Practice Address - Phone:860-943-3006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008912122300000X
GADN013825122300000X
SC8175122300000X
CA54909122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA351298824CMedicaid