Provider Demographics
NPI:1356378046
Name:SEYWERD, MARJAN S (DDS)
Entity type:Individual
Prefix:DR
First Name:MARJAN
Middle Name:S
Last Name:SEYWERD
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:PO BOX 257
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04332-0257
Mailing Address - Country:US
Mailing Address - Phone:207-622-1564
Mailing Address - Fax:207-622-9630
Practice Address - Street 1:516 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-7739
Practice Address - Country:US
Practice Address - Phone:207-622-1564
Practice Address - Fax:207-622-9630
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
ME33721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice