Provider Demographics
NPI:1548401227
Name:BEW ENTERPRISES, INC.
Entity Type:Organization
Organization Name:BEW ENTERPRISES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:EMMETT
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-854-5001
Mailing Address - Street 1:105 N BROOKS ST
Mailing Address - Street 2:
Mailing Address - City:PELAHATCHIE
Mailing Address - State:MS
Mailing Address - Zip Code:39145-3091
Mailing Address - Country:US
Mailing Address - Phone:601-854-5001
Mailing Address - Fax:601-854-6198
Practice Address - Street 1:105 N BROOKS ST
Practice Address - Street 2:
Practice Address - City:PELAHATCHIE
Practice Address - State:MS
Practice Address - Zip Code:39145-3091
Practice Address - Country:US
Practice Address - Phone:601-854-5001
Practice Address - Fax:601-854-6198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-10
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2698961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00660353Medicaid
MS00060471Medicaid
MS04400322Medicaid