Provider Demographics
NPI:1154929594
Name:SEAN R O'BRIEN
Entity type:Organization
Organization Name:SEAN R O'BRIEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-397-5500
Mailing Address - Street 1:1716 S LILLEY RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-1108
Mailing Address - Country:US
Mailing Address - Phone:734-397-5500
Mailing Address - Fax:734-394-2528
Practice Address - Street 1:1716 S LILLEY RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-1108
Practice Address - Country:US
Practice Address - Phone:734-397-5500
Practice Address - Fax:734-394-2528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental