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General NPI Number Information
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NPI Number | 1841250743
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Entity Type | Individual
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Provider Name | SEAN D. WALCOTT DDS
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Gender | Male
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Dates
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Enumeration Date | 03/24/2006
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Last Update Date | 08/14/2024
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Provider Practice Location Address
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Address Line | 1301 GRASSLANDS BLVD STE 200
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City | LAKELAND
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State | FL
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Zip | 33803-5488
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Country | US
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Telephone | 813-885-6555
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Fax | 863-647-3514
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Provider Business Mailing Address
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Address Line | 1301 GRASSLANDS BLVD STE 200
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City | LAKELAND
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State | FL
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Zip | 33803-5488
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Country | US
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Telephone | 813-885-6555
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DN16473
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License Number State | FL
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