Provider Demographics
NPI:1144208786
Name:HEWLETT, MARK E (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:E
Last Name:HEWLETT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 MIDLAND PARK
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-9735
Mailing Address - Country:US
Mailing Address - Phone:502-633-2229
Mailing Address - Fax:502-633-7518
Practice Address - Street 1:223 MIDLAND PARK
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-9735
Practice Address - Country:US
Practice Address - Phone:502-633-2229
Practice Address - Fax:502-633-7518
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY60331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice