Provider Demographics
NPI:1336278688
Name:JEWETT, CHARLES P (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:P
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 1:9021 FOREST HILL AVE
Mailing Address - Street 2:SUITE D1
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-3053
Mailing Address - Country:US
Mailing Address - Phone:804-272-2955
Mailing Address - Fax:
Practice Address - Street 1:9021 FOREST HILL AVE
Practice Address - Street 2:SUITE D1
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-3053
Practice Address - Country:US
Practice Address - Phone:804-272-2955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010066161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice