MEDICARE: DR. SEAN CHRISTOPHER MEEHAN 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	1223G0001X	General Practice Dentistry	12911	NC
2	125Q00000X	Oral Medicine Dentistry	DS-028464-L	PA
3	1223G0001X	General Practice Dentistry	DS-028464-L	PA
4	1223G0001X	General Practice Dentistry	3019-97	MS

General Provider Information

NPI Number	:	1740281724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEAN CHRISTOPHER MEEHAN D.M.D.

Provider Business Mailing Address
First Line	:	240 S 40TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-6030
Country	:	US
Telephone Number	:	215-746-7982
Fax Number	:

Provider Business Practice Location Address
First Line	:	240 S 40TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-6030
Country	:	US
Telephone Number	:	215-746-7982
Fax Number	:

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

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	08/28/2023

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