=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174349369
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SEAN GEARY ENDODONTICS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2024
-----------------------------------------------------
Last Update Date | 12/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8188 S JOG RD STE 204
-----------------------------------------------------
City | BOYNTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33472-2952
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-327-9806
-----------------------------------------------------
Fax | 561-327-6885
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8188 S JOG RD STE 204
-----------------------------------------------------
City | BOYNTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33472-2952
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-327-9806
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER DENTIST
-----------------------------------------------------
Name | SEAN GEARY
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 314-680-8971
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223E0200X
-----------------------------------------------------
Taxonomy Name | Endodontics
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------