Provider Demographics
NPI:1114303641
Name:HEWKO, ALISHA LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALISHA
Middle Name:LEE
Last Name:HEWKO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MS
Other - First Name:ALISHA
Other - Middle Name:LEE
Other - Last Name:HARRIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3630 CENTRAL AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-5908
Mailing Address - Country:US
Mailing Address - Phone:951-335-0466
Mailing Address - Fax:
Practice Address - Street 1:3630 CENTRAL AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-5908
Practice Address - Country:US
Practice Address - Phone:951-335-0466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-06
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA648451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice