Provider Demographics
NPI:1629277868
Name:EWELL, ALLEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:
Last Name:EWELL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9314 W MONTE LINDO
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-4221
Mailing Address - Country:US
Mailing Address - Phone:216-513-4609
Mailing Address - Fax:
Practice Address - Street 1:13954 W WADDELL RD STE 112
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-8751
Practice Address - Country:US
Practice Address - Phone:623-889-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2021-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ72681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice