Provider Demographics
NPI:1578671459
Name:HEWLETT, MARVIN MCCOY JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:MCCOY
Last Name:HEWLETT
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:MARVIN
Other - Middle Name:MCCOY
Other - Last Name:HEWLETT
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DDS PC
Mailing Address - Street 1:402 E COMMERCE STREET
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36037
Mailing Address - Country:US
Mailing Address - Phone:334-382-5431
Mailing Address - Fax:334-382-2492
Practice Address - Street 1:402 E COMMERCE STREET
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:AL
Practice Address - Zip Code:36037
Practice Address - Country:US
Practice Address - Phone:334-382-5431
Practice Address - Fax:334-382-2492
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3171122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL05867OtherBCBS OF ALABAMA