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General NPI Number Information
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NPI Number | 1770853285
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Entity Type | Organization
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Legal Business Name | SEAN P. COONEY, DMD, LLC
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Dates
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Enumeration Date | 01/01/2012
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Last Update Date | 01/01/2012
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Provider Practice Location Address
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Address Line | 30 FENTON PLZ
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City | FENTON
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State | MO
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Zip | 63026-4110
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Country | US
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Telephone | 636-349-0070
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Fax |
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Provider Business Mailing Address
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Address Line | 30 FENTON PLZ
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City | FENTON
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State | MO
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Zip | 63026-4110
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SEAN COONEY
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Credential | DMD
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Telephone | 636-349-0070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 2005018812
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License Number State | MO
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