Provider Demographics
NPI:1316954241
Name:ANDERSON, SEAN M (DDS)
Entity type:Individual
Prefix:MR
First Name:SEAN
Middle Name:M
Last Name:ANDERSON
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 1:1501 BOLLINGER CANYON RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1758
Mailing Address - Country:US
Mailing Address - Phone:925-837-4486
Mailing Address - Fax:925-837-8164
Practice Address - Street 1:1501 BOLLINGER CANYON RD
Practice Address - Street 2:SUITE G
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1758
Practice Address - Country:US
Practice Address - Phone:925-837-4486
Practice Address - Fax:925-837-8164
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42519122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist