Provider Demographics
NPI:1417015769
Name:JACK B DEWEY DDS PA
Entity Type:Organization
Organization Name:JACK B DEWEY DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:CURTIS
Authorized Official - Last Name:DEWEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:561-582-7660
Mailing Address - Street 1:6000 SOUTH DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33405
Mailing Address - Country:US
Mailing Address - Phone:561-582-7660
Mailing Address - Fax:561-588-7316
Practice Address - Street 1:6000 SOUTH DIXIE HWY
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33405
Practice Address - Country:US
Practice Address - Phone:561-582-7660
Practice Address - Fax:561-588-7316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN30851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty