Active NPI
Sean Thomas McDonnell, D.D.S.
- Pediatric Dentistry
- Port Orange, FL
National Provider Identifier
1669442489
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- DN16783
- Practice address
- 1440 Reed Canal Rd
Port Orange, FL 32129-9418 - Phone
- (386) 760-0550
- NPI assigned
- Jan 24, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | DN16783 | FL | Primary |
Addresses
Primary practice location
1440 Reed Canal Rd
Port Orange, FL 32129-9418
Mailing address
323 Desoto Dr
New Smyrna Beach, FL 32169-5208
Phone (386) 871-1702
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN16783 | FL | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138060800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1466467200000",
"number": "1669442489",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "323 DESOTO DR",
"city": "NEW SMYRNA BEACH",
"state": "FL",
"postal_code": "321695208",
"telephone_number": "386-871-1702"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1440 REED CANAL RD",
"city": "PORT ORANGE",
"state": "FL",
"postal_code": "321299418",
"telephone_number": "386-760-0550"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCDONNELL",
"first_name": "SEAN",
"middle_name": "THOMAS",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-24",
"last_updated": "2016-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "FL",
"license": "DN16783",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Orange, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 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.