Individual
SEAN STACY PHELAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2010 JUAN TABO BLVD NE, ALBUQUERQUE, NM 87112-3306
(505) 237-2273
(505) 323-9294
Mailing address
2010 JUAN TABO BLVD NE, ALBUQUERQUE, NM 87112-3306
(505) 237-2273
(505) 323-9294
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DD2712
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
413131
UNITED CONCORDIA
NM
Enumeration date
07/28/2006
Last updated
07/08/2007
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