Provider Demographics
NPI:1679786206
Name:FESSENDEN, SEAN D
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:D
Last Name:FESSENDEN
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 1:7555 CENTER VIEW CT
Mailing Address - Street 2:202
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-1970
Mailing Address - Country:US
Mailing Address - Phone:801-282-4333
Mailing Address - Fax:801-282-5599
Practice Address - Street 1:7555 CENTER VIEW CT
Practice Address - Street 2:202
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-1970
Practice Address - Country:US
Practice Address - Phone:801-282-4333
Practice Address - Fax:801-282-5599
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT370656-99221223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics