Healthcare Provider Details

I. General information

NPI: 1306294566
Provider Name (Legal Business Name): EMILY MARIE SEWELL D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2016
Last Update Date: 05/19/2024
Certification Date: 05/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 RIDGELY AVE STE 12B
ANNAPOLIS MD
21401-1415
US

IV. Provider business mailing address

572 RITCHIE HWY STE F
SEVERNA PARK MD
21146-2966
US

V. Phone/Fax

Practice location:
  • Phone: 410-267-0766
  • Fax:
Mailing address:
  • Phone: 570-498-2177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number15966
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number15966
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: