Active NPI
Michael E Ewert, DDS
- Dentist
- Crestline, CA
National Provider Identifier
1407160658
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 32458
- Practice address
- 580 Forest Shade Rd #2
Crestline, CA 92325 - Phone
- (909) 338-7731
- Fax
- (909) 338-8162
- NPI assigned
- Jul 29, 2010
- Last updated
- Jul 29, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 32458 | CA | Primary |
Addresses
Primary practice location
580 Forest Shade Rd #2
Crestline, CA 92325
Mailing address
PO Box 4093
Crestline, CA 92325
Phone (909) 338-7731
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1280361600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1280361600000",
"number": "1407160658",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 4093",
"city": "CRESTLINE",
"state": "CA",
"postal_code": "92325",
"telephone_number": "909-338-7731",
"fax_number": "909-338-8162"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "580 FOREST SHADE RD #2",
"city": "CRESTLINE",
"state": "CA",
"postal_code": "92325",
"telephone_number": "909-338-7731",
"fax_number": "909-338-8162"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EWERT",
"first_name": "MICHAEL",
"middle_name": "E",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-07-29",
"last_updated": "2010-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "32458",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Crestline, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.