Provider Demographics
NPI:1336651561
Name:JONATHAN MCEWEN DDS, PLLC
Entity Type:Organization
Organization Name:JONATHAN MCEWEN DDS, PLLC
Other - Org Name:MCEWEN FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:MCEWEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-210-7079
Mailing Address - Street 1:9318 STRATFORD PL
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-4299
Mailing Address - Country:US
Mailing Address - Phone:281-210-7079
Mailing Address - Fax:
Practice Address - Street 1:20212 CHAMPION FOREST DR STE 400
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-8698
Practice Address - Country:US
Practice Address - Phone:832-303-5414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-27
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX247011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty