Provider Demographics
NPI:1881779387
Name:SEJUD, PAUL VINCENT (DMD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:VINCENT
Last Name:SEJUD
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 1:1111 SONOMA AVE #220
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4833
Mailing Address - Country:US
Mailing Address - Phone:707-566-7300
Mailing Address - Fax:707-566-7400
Practice Address - Street 1:1111 SONOMA AVE #220
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4833
Practice Address - Country:US
Practice Address - Phone:707-566-7300
Practice Address - Fax:707-566-7400
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC5939675122300000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery