Provider Demographics
NPI:1639485303
Name:JEW, MARY M (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:M
Last Name:JEW
Suffix:
Gender:F
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:PO BOX 15013
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92623-5013
Mailing Address - Country:US
Mailing Address - Phone:949-689-2282
Mailing Address - Fax:
Practice Address - Street 1:4980 BARRANCA PKWY
Practice Address - Street 2:SUITE 150
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-8645
Practice Address - Country:US
Practice Address - Phone:949-689-2282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-19
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA354101223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics