Provider Demographics
NPI:1154345734
Name:DALY, SEAN MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:MICHAEL
Last Name:DALY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2217 W 12TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-3660
Mailing Address - Country:US
Mailing Address - Phone:402-463-6664
Mailing Address - Fax:402-463-6900
Practice Address - Street 1:2217 W 12TH ST STE 1
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-3660
Practice Address - Country:US
Practice Address - Phone:402-463-6664
Practice Address - Fax:402-463-6900
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE64001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE760734095OtherTAX ID
NE10024972100Medicaid