Provider Demographics
NPI:1700974029
Name:SEWELL, D'JONNA LYNNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:D'JONNA
Middle Name:LYNNE
Last Name:SEWELL
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 1:740 SHERIDAN LAKE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-0900
Mailing Address - Country:US
Mailing Address - Phone:605-341-0826
Mailing Address - Fax:
Practice Address - Street 1:740 SHERIDAN LAKE RD
Practice Address - Street 2:SUITE A
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-0900
Practice Address - Country:US
Practice Address - Phone:605-341-0826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM7211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7805960Medicaid