Provider Demographics
NPI:1568775666
Name:MCEWAN, MICHAEL BERRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BERRY
Last Name:MCEWAN
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 1:243 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-9223
Mailing Address - Country:US
Mailing Address - Phone:541-892-2975
Mailing Address - Fax:
Practice Address - Street 1:1512 GRAND AVE
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-3861
Practice Address - Country:US
Practice Address - Phone:970-945-2588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO106041223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics