Provider Demographics
NPI:1891241196
Name:HEWLETT, MIKE (DMD)
Entity Type:Individual
Prefix:
First Name:MIKE
Middle Name:
Last Name:HEWLETT
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 1:122 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-2281
Mailing Address - Country:US
Mailing Address - Phone:269-262-4364
Mailing Address - Fax:
Practice Address - Street 1:261 M-62
Practice Address - Street 2:
Practice Address - City:CASSOPOLIS
Practice Address - State:MI
Practice Address - Zip Code:49031
Practice Address - Country:US
Practice Address - Phone:269-445-3874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901022012122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist