Michael E Ewert, DDS
Individual provider Active NPI Dentist · Crestline, CA
NPI 1407160658 · NPPES record last updated Jul 29, 2010
Key facts
- NPI
- 1407160658
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 32458 (CA)
- Practice address
- 580 Forest Shade Rd #2
Crestline, CA 92325 - Phone
- (909) 338-7731
- Fax
- (909) 338-8162
- NPI assigned
- Jul 29, 2010
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 32458 | CA | Yes |
Addresses
Primary practice location
580 Forest Shade Rd #2
Crestline, CA 92325
Mailing address
PO Box 4093
Crestline, CA 92325
Phone (909) 338-7731
Other providers in Crestline, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 29, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.