Provider Demographics
NPI:1992394225
Name:RICHARD J EWING DDS INC.
Entity Type:Organization
Organization Name:RICHARD J EWING DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:EWING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-408-7755
Mailing Address - Street 1:3340 KEMPER ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-4908
Mailing Address - Country:US
Mailing Address - Phone:619-224-2828
Mailing Address - Fax:
Practice Address - Street 1:3340 KEMPER ST STE 201
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-4908
Practice Address - Country:US
Practice Address - Phone:619-224-2828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental