Provider Demographics
NPI:1760542153
Name:TEW, DARRELL K (DDS)
Entity Type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:K
Last Name:TEW
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 1:5000 W NOB HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3746
Mailing Address - Country:US
Mailing Address - Phone:509-853-3622
Mailing Address - Fax:509-853-3623
Practice Address - Street 1:5000 W NOB HILL BLVD
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3746
Practice Address - Country:US
Practice Address - Phone:509-853-3622
Practice Address - Fax:509-853-3623
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000066911223P0106X
WA9120934151223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB37341Medicare UPIN