Provider Demographics
NPI:1053444539
Name:JEWETT, TONY C (DDS)
Entity Type:Individual
Prefix:DR
First Name:TONY
Middle Name:C
Last Name:JEWETT
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 1:236 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-5311
Mailing Address - Country:US
Mailing Address - Phone:530-342-8314
Mailing Address - Fax:530-342-8362
Practice Address - Street 1:236 W 3RD ST
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-5311
Practice Address - Country:US
Practice Address - Phone:530-342-8314
Practice Address - Fax:530-342-8362
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA318061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice