Provider Demographics
NPI:1932529773
Name:SEVILLA, GERALDINE (DDS)
Entity type:Individual
Prefix:
First Name:GERALDINE
Middle Name:
Last Name:SEVILLA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 E 38TH STREET
Mailing Address - Street 2:APT. 2F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:212-685-9243
Mailing Address - Fax:212-972-0410
Practice Address - Street 1:155 E 38TH ST APT 2F
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-2671
Practice Address - Country:US
Practice Address - Phone:212-685-9243
Practice Address - Fax:212-972-0410
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-20
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY057640122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program