Healthcare Provider Details

I. General information

NPI: 1194158766
Provider Name (Legal Business Name): SEAN T O'DAY DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2013
Last Update Date: 08/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 US HIGHWAY 23
PIKETON OH
45661
US

IV. Provider business mailing address

47 N POHLMAN RD
CHILLICOTHEE OH
45601-3051
US

V. Phone/Fax

Practice location:
  • Phone: 740-289-3508
  • Fax:
Mailing address:
  • Phone: 815-218-1022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS-09040
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number019029701
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30-024559
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: