Provider Demographics
NPI:1225065881
Name:SEBOLD, CANDY ELLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CANDY
Middle Name:ELLEN
Last Name:SEBOLD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2248 E 21ST ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3638
Mailing Address - Country:US
Mailing Address - Phone:718-646-1378
Mailing Address - Fax:718-646-1378
Practice Address - Street 1:2248 E 21ST ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3638
Practice Address - Country:US
Practice Address - Phone:718-646-1378
Practice Address - Fax:718-646-1378
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0357071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice