Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 0442000334 | VA |
N | 204E00000X | Oral & Maxillofacial Surgeon | 0442000334 | VA |
NPI | 1437649431 |
---|---|
Provider Name | Sean Eccles |
First Address | Richmond, VA 23298-0566 |
Second Address | Richmond, VA 23298-5051 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2018 |
Last Update Date | 18/09/2019 |