Healthcare Provider Details

I. General information

NPI: 1134323371
Provider Name (Legal Business Name): DAVID ANDREW SEWELL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

546 W SEMINARY DR SUITE C
FORT WORTH TX
76115-1361
US

IV. Provider business mailing address

546 W SEMINARY DR SUITE C
FORT WORTH TX
76115-1361
US

V. Phone/Fax

Practice location:
  • Phone: 817-924-0091
  • Fax: 817-924-0014
Mailing address:
  • Phone: 817-924-0091
  • Fax: 817-924-0014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number09947
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: