Provider Demographics
NPI:1104105907
Name:SEWITCH, THEODORE (DMD MS)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:
Last Name:SEWITCH
Suffix:
Gender:M
Credentials:DMD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 EAST 56TH STREET
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022
Mailing Address - Country:US
Mailing Address - Phone:212-753-7672
Mailing Address - Fax:212-758-6822
Practice Address - Street 1:60 EAST 56TH STREET
Practice Address - Street 2:5TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022
Practice Address - Country:US
Practice Address - Phone:212-753-7672
Practice Address - Fax:212-758-6822
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY38444122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist