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General NPI Number Information
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NPI Number | 1740163542
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Entity Type | Individual
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Provider Name | SEAN PORATH DMD
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Gender | Male
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Dates
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Enumeration Date | 07/29/2025
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 122 LEE BLVD
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City | SHELBYVILLE
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State | IN
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Zip | 46176-3403
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Country | US
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Telephone | 317-398-6399
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Fax |
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Provider Business Mailing Address
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Address Line | 670 1ST AVE NW
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City | CARMEL
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State | IN
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Zip | 46032-1330
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Country | US
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Telephone | 989-395-1560
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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 | 12014846A
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License Number State | IN
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