Healthcare Provider Details

I. General information

NPI: 1578185955
Provider Name (Legal Business Name): SEAN LAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2020
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5635 PEACHTREE PKWY STE 200
PEACHTREE CORNERS GA
30092-2823
US

IV. Provider business mailing address

5635 PEACHTREE PKWY STE 200
PEACHTREE CORNERS GA
30092-2823
US

V. Phone/Fax

Practice location:
  • Phone: 404-999-2769
  • Fax:
Mailing address:
  • Phone: 678-990-1001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN24949
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: