Provider Demographics
NPI:1083974752
Name:EWERT, TIMOTHY JARRED (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JARRED
Last Name:EWERT
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 1:5001 PLAINFIELD AVE NE STE A
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-1050
Mailing Address - Country:US
Mailing Address - Phone:616-364-7039
Mailing Address - Fax:
Practice Address - Street 1:5001 PLAINFIELD AVE NE STE A
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-1050
Practice Address - Country:US
Practice Address - Phone:616-364-7039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010206611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice