Provider Demographics
NPI:1447346051
Name:EWELL ROSENBERGER, SHERRELYN DIANE (DMD)
Entity type:Individual
Prefix:DR
First Name:SHERRELYN
Middle Name:DIANE
Last Name:EWELL ROSENBERGER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:SHERRELYN
Other - Middle Name:D
Other - Last Name:EWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1133 HOWDERSHELL ROAD
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031
Mailing Address - Country:US
Mailing Address - Phone:314-839-9339
Mailing Address - Fax:314-839-0866
Practice Address - Street 1:1133 HOWDERSHELL ROAD
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031
Practice Address - Country:US
Practice Address - Phone:314-839-9339
Practice Address - Fax:314-839-0866
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO133791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice