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General NPI Number Information
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NPI Number | 1003005547
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Entity Type | Individual
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Provider Name | SEAN PHUC DO DMD
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Gender | Male
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Dates
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Enumeration Date | 10/22/2007
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Last Update Date | 02/15/2011
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Provider Practice Location Address
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Address Line | 1341 S MILITARY HWY
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City | CHESAPEAKE
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State | VA
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Zip | 23320-2513
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Country | US
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Telephone | 757-447-7333
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Fax | 757-394-3394
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Provider Business Mailing Address
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Address Line | 1341 S MILITARY HWY
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City | CHESAPEAKE
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State | VA
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Zip | 23320-2513
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Country | US
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Telephone | 757-447-7333
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Fax | 757-394-3394
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401411673
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 0401411673
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License Number State | VA
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