Provider Demographics
NPI:1821042706
Name:SEWALL, STEVEN R (DDS)
Entity Type:Individual
Prefix:MS
First Name:STEVEN
Middle Name:R
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 1:840 N 87TH ST
Mailing Address - Street 2:ORAL AND MAXILLOFACIAL SURGERY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3586
Mailing Address - Country:US
Mailing Address - Phone:414-805-5781
Mailing Address - Fax:414-259-9115
Practice Address - Street 1:840 N 87TH ST
Practice Address - Street 2:ORAL AND MAXILLOFACIAL SURGERY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3586
Practice Address - Country:US
Practice Address - Phone:414-805-5781
Practice Address - Fax:414-259-9115
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50021501223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1821042706Medicaid
002000135HOtherHUMANA
002000135HOtherHUMANA
WI1821042706Medicaid