Healthcare Provider Details

I. General information

NPI: 1245736610
Provider Name (Legal Business Name): DR. SEAN MICHAEL MCGUIRE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 09/06/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10759 WINTERSET DR
ORLAND PARK IL
60467-1106
US

IV. Provider business mailing address

76 LONG COVE DR
LEMONT IL
60439-7730
US

V. Phone/Fax

Practice location:
  • Phone: 309-230-8344
  • Fax:
Mailing address:
  • Phone: 309-230-8344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number019.033573
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number12014309A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: