Healthcare Provider Details

I. General information

NPI: 1730511247
Provider Name (Legal Business Name): SEWELL DENTAL CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2013
Last Update Date: 08/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202A KINGS WAY W
SEWELL NJ
08080-2200
US

IV. Provider business mailing address

202A KINGS WAY W
SEWELL NJ
08080-2200
US

V. Phone/Fax

Practice location:
  • Phone: 856-589-2298
  • Fax:
Mailing address:
  • Phone: 856-589-2298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI02245700
License Number StateNJ

VIII. Authorized Official

Name: DR. CHIAWEI WU
Title or Position: OWNER
Credential: DDS
Phone: 856-589-2298