Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 0401411673 | VA |
Y | 1223P0221X | Pediatric Dentist | 0401411673 | VA |
NPI | 1003005547 |
---|---|
Provider Name | Dr. Sean Phuc Do |
First Address | Chesapeake, VA 23320-2513 |
Second Address | Chesapeake, VA 23320-2513 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2007 |
Last Update Date | 15/02/2011 |