Provider Demographics
NPI:1316623069
Name:THOMAS, SEAN CHRISTOPHER (DMD)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:CHRISTOPHER
Last Name:THOMAS
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 1:555 INVERNESS
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48357-4772
Mailing Address - Country:US
Mailing Address - Phone:248-660-7096
Mailing Address - Fax:
Practice Address - Street 1:2565 S ROCHESTER RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-4472
Practice Address - Country:US
Practice Address - Phone:947-252-2858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-27
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901601822122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2901601822OtherDEPARTMENT OF LICENSING AND REGULATORY AFFAIRS BOARD OF DENTISTRY