MEDICARE: DR. SEAN DONOVAN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	5076-015	WI
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	5076	WI

General Provider Information

NPI Number	:	1508852260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEAN DONOVAN DDS

Provider Business Mailing Address
First Line	:	PSC 819 BOX 4420
Second Line	:
City	:	FPO
State	:	AE
Zip	:	09645
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	PSC 819 BOX 4420
Second Line	:
City	:	FPO
State	:	AE
Zip	:	09645-0045
Country	:	US
Telephone Number	:	34956823733
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	10/28/2015

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Directions to “ DR. SEAN DONOVAN DDS” Practice Location

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