Provider Demographics
NPI:1306409479
Name:ROBERTS, SEAN (DMD)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27203 216TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-3273
Mailing Address - Country:US
Mailing Address - Phone:425-432-1232
Mailing Address - Fax:425-432-2043
Practice Address - Street 1:27203 216TH AVE SE
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-3273
Practice Address - Country:US
Practice Address - Phone:425-432-1232
Practice Address - Fax:425-432-2043
Is Sole Proprietor?:No
Enumeration Date:2019-04-15
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA615341391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice