Provider Demographics
NPI:1376326009
Name:JEWELL ORTHODONTICS, LLC
Entity Type:Organization
Organization Name:JEWELL ORTHODONTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABBY
Authorized Official - Middle Name:
Authorized Official - Last Name:JEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-560-8351
Mailing Address - Street 1:2350 SW RIVER TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64082-7804
Mailing Address - Country:US
Mailing Address - Phone:816-560-8351
Mailing Address - Fax:
Practice Address - Street 1:2070 NW LOWENSTEIN DR
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081-1903
Practice Address - Country:US
Practice Address - Phone:816-560-8351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty