Provider Demographics
NPI:1407066152
Name:PERSAUD, SEWAH (DMD)
Entity Type:Individual
Prefix:DR
First Name:SEWAH
Middle Name:
Last Name:PERSAUD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 PROVIDENCE MAIN ST NW
Mailing Address - Street 2:SUITE #301
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-4815
Mailing Address - Country:US
Mailing Address - Phone:256-489-5600
Mailing Address - Fax:256-489-5640
Practice Address - Street 1:475 PROVIDENCE MAIN ST NW
Practice Address - Street 2:SUITE #301
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-4815
Practice Address - Country:US
Practice Address - Phone:256-489-5600
Practice Address - Fax:256-489-5640
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL50911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice