Provider Demographics
NPI:1033207139
Name:EWING, DAVID LEE (DDS)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LEE
Last Name:EWING
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1058 N IRISH RD
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-2209
Mailing Address - Country:US
Mailing Address - Phone:810-653-4100
Mailing Address - Fax:810-658-7526
Practice Address - Street 1:1058 N IRISH RD
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-2209
Practice Address - Country:US
Practice Address - Phone:810-653-4100
Practice Address - Fax:810-658-7526
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010112911223G0001X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies