Provider Demographics
NPI:1386396331
Name:JEREMY JAY SEWELL DMD PC
Entity type:Organization
Organization Name:JEREMY JAY SEWELL DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:SEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:951-699-0700
Mailing Address - Street 1:32449 CASTLE CT
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-7110
Mailing Address - Country:US
Mailing Address - Phone:951-238-0209
Mailing Address - Fax:
Practice Address - Street 1:29740 RANCHO CALIFORNIA RD STE 100
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-5287
Practice Address - Country:US
Practice Address - Phone:951-238-0209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-21
Last Update Date:2022-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty