MEDICARE: DR. SEAN MCGREGOR D.M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program		FL
2	1223G0001X	General Practice Dentistry	DN29344	FL

General Provider Information

NPI Number	:	1164261947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEAN MCGREGOR D.M.D

Provider Business Mailing Address
First Line	:	12460 SUNGLOW BLVD # 6-112
Second Line	:
City	:	VENICE
State	:	FL
Zip	:	34293-2579
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5696 TUSCOLA BLVD
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34287-2738
Country	:	US
Telephone Number	:	941-732-8141
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2024
Last Update Date	:	07/11/2024

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