Provider Demographics
NPI:1619619871
Name:EWANE, CARINE EBUDE (X2)
Entity Type:Individual
Prefix:
First Name:CARINE
Middle Name:EBUDE
Last Name:EWANE
Suffix:
Gender:F
Credentials:X2
Other - Prefix:
Other - First Name:FNU
Other - Middle Name:
Other - Last Name:EBUDE EWANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1667 COCHRANE CIR BLDG 7495
Mailing Address - Street 2:
Mailing Address - City:FORT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913-4603
Mailing Address - Country:US
Mailing Address - Phone:719-526-5537
Mailing Address - Fax:
Practice Address - Street 1:USA DENTAL ACTIVITY 1060 GAFFNEY RD #7500
Practice Address - Street 2:
Practice Address - City:FORT WAINRIGHT
Practice Address - State:AK
Practice Address - Zip Code:99703
Practice Address - Country:US
Practice Address - Phone:240-841-5458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-08
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant