Justin Ewell, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DD4518 Issued in NM

Practice address

3501 N Butler Ave
Suite 104
Farmington, NM 87401-6429

Phone

(505) 564-4470

Fax

(505) 325-9707

NPI assigned

Jun 5, 2016

Last updated

Jun 5, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Fairway Dental Az PLLC

  • Dental Clinic/Center
  • Litchfield Park, AZ
  • NPI 1609730779
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1465084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465084800000",
    "number": "1033568688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3501 N BUTLER AVE",
            "address_2": "SUITE 104",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874016429",
            "telephone_number": "505-564-4470",
            "fax_number": "505-325-9707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3501 N BUTLER AVE",
            "address_2": "SUITE 104",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874016429",
            "telephone_number": "505-564-4470",
            "fax_number": "505-325-9707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EWELL",
        "first_name": "JUSTIN",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-05",
        "last_updated": "2016-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NM",
            "license": "DD4518",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Liandra Etcitty, LMSW
• Eubank Counseling Center, LLC
• Linda Ann Eubank, MA
• William P Eubank, MS, MA
• Kristy Jo Ella Evans, COTA
• Carol Lynn Ewing, CNM
• Excel Case Management, Inc.
• Exceptional Physicians Group Farmington Hospital PLLC
• Exodus Peer to Peer Recovery Center
• Eye Associates of New Mexico, LTD. (Eye Associates of New Mexico)

• General Practice Dentistry in Farmington, NM
• Providers in Farmington, NM by specialty
• General Practice Dentistry in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.