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General NPI Number Information
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NPI Number | 1639274855
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Entity Type | Individual
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Provider Name | CONSTANCE LEE SEDON DMD
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Gender | Female
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 06/09/2022
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Provider Practice Location Address
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Address Line | 9225 DOERR RD
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City | FORT BELVOIR
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State | VA
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Zip | 22060-2204
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Country | US
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Telephone | 571-231-6004
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Fax |
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Provider Business Mailing Address
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Address Line | 8810 FIRCREST PL
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City | ALEXANDRIA
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State | VA
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Zip | 22308-2632
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Country | US
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Telephone | 502-558-7616
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Fax |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 8407
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DS035468
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License Number State | PA
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