Provider Demographics
NPI:1033777891
Name:SEWELL, CAROLINE (DMD)
Entity type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:
Last Name:SEWELL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8517 W OVERLAND RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-1644
Mailing Address - Country:US
Mailing Address - Phone:800-729-0069
Mailing Address - Fax:208-895-8540
Practice Address - Street 1:1067 S WELLS ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-7997
Practice Address - Country:US
Practice Address - Phone:208-895-8480
Practice Address - Fax:208-895-8540
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-50361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice