Provider Demographics
NPI:1164468732
Name:SEWALL, RICHARD STEPHEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:STEPHEN
Last Name:SEWALL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 390
Mailing Address - Street 2:
Mailing Address - City:EAST WILTON
Mailing Address - State:ME
Mailing Address - Zip Code:04234-0390
Mailing Address - Country:US
Mailing Address - Phone:207-645-9522
Mailing Address - Fax:207-645-9516
Practice Address - Street 1:1445 MAIN STREET
Practice Address - Street 2:
Practice Address - City:EAST WILTON
Practice Address - State:ME
Practice Address - Zip Code:04234
Practice Address - Country:US
Practice Address - Phone:207-645-9522
Practice Address - Fax:207-645-9516
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME25691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice