Healthcare Provider Details

I. General information

NPI: 1033236559
Provider Name (Legal Business Name): SEAN ROBERT OBRIEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1716 S LILLEY RD
CANTON MI
48188-1108
US

IV. Provider business mailing address

1716 S LILLEY RD
CANTON MI
48188-1108
US

V. Phone/Fax

Practice location:
  • Phone: 734-397-5500
  • Fax: 734-394-2528
Mailing address:
  • Phone: 734-397-5500
  • Fax: 734-394-2528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number013712
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: