Provider Demographics
NPI:1306458344
Name:SHARIFALI, SEAN
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:SHARIFALI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2335 SUGARLOAF CLUB DR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-7404
Mailing Address - Country:US
Mailing Address - Phone:678-777-6624
Mailing Address - Fax:
Practice Address - Street 1:19 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:GA
Practice Address - Zip Code:30747-1251
Practice Address - Country:US
Practice Address - Phone:706-810-5996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN016118122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist