Provider Demographics
NPI:1124863865
Name:SEAN M. ALTENBACH, D.M.D., P.L.
Entity type:Organization
Organization Name:SEAN M. ALTENBACH, D.M.D., P.L.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTENBACH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:904-422-4150
Mailing Address - Street 1:8841 SAN JOSE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-4244
Mailing Address - Country:US
Mailing Address - Phone:904-448-0441
Mailing Address - Fax:904-448-0456
Practice Address - Street 1:8841 SAN JOSE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-4244
Practice Address - Country:US
Practice Address - Phone:904-448-0441
Practice Address - Fax:904-448-0456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental