Michael Sebourn, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5659 Issued in OK

Practice address

810 W Church St
Greeneville, TN 37745-3285

Phone

(423) 798-1755

NPI assigned

Jan 19, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Caltre LLC

  • Dentist
  • Edmond, OK
  • NPI 1235107822
  NPD (past)
• Ronald Montgomery Dental Group, PC

  • General Practice Dentistry
  • Edmond, OK
  • NPI 1033519012
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464652800000",
    "number": "1659424133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 SHANE ST",
            "city": "GREENEVILLE",
            "state": "TN",
            "postal_code": "377439203",
            "telephone_number": "405-517-1115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 W CHURCH ST",
            "city": "GREENEVILLE",
            "state": "TN",
            "postal_code": "377453285",
            "telephone_number": "423-798-1755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEBOURN",
        "first_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-19",
        "last_updated": "2016-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OK",
            "license": "5659",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200045920A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joan Marie Scott , MMSC, Rd, LDN, Cde, MMSC, RD, LDN, CDE
• William Joseph Scott, MD
• Crystal B. Seals, PTA
• Cindy Regina Seaton, RD/LDN
• Shannon N. W. Seaton, M. A., SLPE
• Ashley Self, REGISTERED DIETITIAN
• Anindya Kumar Sen, MD F.A.C.P.
• Shadybrook
• Jennifer L Sharp-Saunders, MD
• John L. Shaw, M.D.

• General Practice Dentistry in Greeneville, TN
• Providers in Greeneville, TN by specialty
• General Practice Dentistry in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.