Provider Demographics
NPI:1295930196
Name:BEWICK DENTAL CORP
Entity type:Organization
Organization Name:BEWICK DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:BEWICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-762-5288
Mailing Address - Street 1:3410 WILLOWCREEK RD
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-5089
Mailing Address - Country:US
Mailing Address - Phone:219-762-5288
Mailing Address - Fax:219-763-3369
Practice Address - Street 1:3410 WILLOWCREEK RD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-5089
Practice Address - Country:US
Practice Address - Phone:219-762-5288
Practice Address - Fax:219-763-3369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008296A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty