Provider Demographics
NPI:1548228885
Name:JEWSON, DOUGLAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
Last Name:JEWSON
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 1:3712 BONTURA DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-3206
Mailing Address - Country:US
Mailing Address - Phone:336-288-9740
Mailing Address - Fax:
Practice Address - Street 1:5318 W FRIENDLY AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-4349
Practice Address - Country:US
Practice Address - Phone:336-299-9500
Practice Address - Fax:336-854-1620
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5503122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist