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Individual

DR. MICHAEL SEBOURN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
810 W CHURCH ST, GREENEVILLE, TN 37745-3285
(423) 798-1755
Mailing address
103 SHANE ST, GREENEVILLE, TN 37743-9203
(405) 517-1115

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5659
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200045920A
OK
Enumeration date
01/19/2007
Last updated
05/31/2016
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