Provider Demographics
NPI:1265270680
Name:LUANGPRASEUTH, SEAN SOMCHENE (DDS)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:SOMCHENE
Last Name:LUANGPRASEUTH
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 1:3443 W VILLA DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-8737
Mailing Address - Country:US
Mailing Address - Phone:414-940-9884
Mailing Address - Fax:
Practice Address - Street 1:8001 W NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-4507
Practice Address - Country:US
Practice Address - Phone:414-327-6363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-18
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6001631-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist