MEDICARE: DR. SEWAH PERSAUD D.M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	5091	AL

General Provider Information

NPI Number	:	1407066152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEWAH PERSAUD D.M.D

Provider Business Mailing Address
First Line	:	475 PROVIDENCE MAIN ST NW
Second Line	:	SUITE #301
City	:	HUNTSVILLE
State	:	AL
Zip	:	35806-4815
Country	:	US
Telephone Number	:	256-489-5600
Fax Number	:	256-489-5640

Provider Business Practice Location Address
First Line	:	475 PROVIDENCE MAIN ST NW
Second Line	:	SUITE #301
City	:	HUNTSVILLE
State	:	AL
Zip	:	35806-4815
Country	:	US
Telephone Number	:	256-489-5600
Fax Number	:	256-489-5640

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/08/2007

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