Provider Demographics
NPI:1649221136
Name:MCEWEN, PAUL DANIEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DANIEL
Last Name:MCEWEN
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 1:510 SOUTH BRIDGE ST.
Mailing Address - Street 2:P.O. BOX 717
Mailing Address - City:LINDEN
Mailing Address - State:MI
Mailing Address - Zip Code:48451-0717
Mailing Address - Country:US
Mailing Address - Phone:810-735-7511
Mailing Address - Fax:810-735-0918
Practice Address - Street 1:510 S BRIDGE ST.
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:MI
Practice Address - Zip Code:48451-0717
Practice Address - Country:US
Practice Address - Phone:810-735-7511
Practice Address - Fax:810-735-0918
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010104541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4040855Medicaid
MI5257585Medicare ID - Type Unspecified