MEDICARE: DR. SEAN LEON ESCHENBACH DDS

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
2	122300000X	Dentist	DR60361086	WA
3	1223G0001X	General Practice Dentistry	0401414392	VA

General Provider Information

NPI Number	:	1699016956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEAN LEON ESCHENBACH DDS

Provider Business Mailing Address
First Line	:	6027 PETERS CREEK RD
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24019-4029
Country	:	US
Telephone Number	:	540-366-5373
Fax Number	:

Provider Business Practice Location Address
First Line	:	6027 PETERS CREEK RD
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24019-4029
Country	:	US
Telephone Number	:	540-366-5373
Fax Number	:

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

Provider Enumeration Date	:	03/12/2013
Last Update Date	:	03/23/2016

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