MEDICARE: DR. CONSTANCE LEE SEDON DMD

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	1223G0001X	General Practice Dentistry	8407	KY
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DS035468	PA

General Provider Information

NPI Number	:	1639274855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CONSTANCE LEE SEDON DMD

Provider Business Mailing Address
First Line	:	8810 FIRCREST PL
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22308-2632
Country	:	US
Telephone Number	:	502-558-7616
Fax Number	:

Provider Business Practice Location Address
First Line	:	9225 DOERR RD
Second Line	:
City	:	FORT BELVOIR
State	:	VA
Zip	:	22060-2204
Country	:	US
Telephone Number	:	571-231-6004
Fax Number	:

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

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	06/09/2022

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