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General NPI Number Information
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NPI Number | 1467619338
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Entity Type | Organization
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Legal Business Name | SEAN E. PATRICK, DDS, PA
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Dates
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Enumeration Date | 05/19/2008
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Last Update Date | 10/02/2012
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Provider Practice Location Address
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Address Line | 2522 PLANTATION CENTER DR SUITE A
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City | MATTHEWS
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State | NC
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Zip | 28105-5298
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Country | US
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Telephone | 704-845-9399
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Fax |
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Provider Business Mailing Address
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Address Line | 2522 PLANTATION CENTER DR SUITE A
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City | MATTHEWS
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State | NC
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Zip | 28105-5298
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Country | US
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Telephone | 704-845-9399
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. SEAN PATRICK
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Credential | DDS
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Telephone | 704-845-9399
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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 | 7164
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License Number State | NC
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