Healthcare Provider Details

I. General information

NPI: 1255585725
Provider Name (Legal Business Name): SEAN BRIANT MCKEOWN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2008
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6287 S REDWOOD RD STE 102
SALT LAKE CITY UT
84123-6653
US

IV. Provider business mailing address

6287 S REDWOOD RD STE 102
SALT LAKE CITY UT
84123-6653
US

V. Phone/Fax

Practice location:
  • Phone: 801-293-8833
  • Fax:
Mailing address:
  • Phone: 801-293-8833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number57636
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number7994731-9924
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: