Provider Demographics
NPI:1841671518
Name:DEKOW, SEAN (DMD, MBE)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:
Last Name:DEKOW
Suffix:
Gender:M
Credentials:DMD, MBE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USA DENTAL ACTIVITY
Mailing Address - Street 2:BLDG 6-6837 NORMANDY DR
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310-7302
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:USA DENTAL ACTIVITY
Practice Address - Street 2:BLDG 6-6837 NORMANDY DR
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-7302
Practice Address - Country:US
Practice Address - Phone:910-643-2196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10347122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist