Provider Demographics
NPI:1669750493
Name:JEWETT, CHELSEA LYNN (RDH)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:LYNN
Last Name:JEWETT
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:LYNN
Other - Last Name:FLAHERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3750 COMMERCIAL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-3117
Mailing Address - Country:US
Mailing Address - Phone:210-334-3700
Mailing Address - Fax:210-922-0162
Practice Address - Street 1:3750 COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78221-3117
Practice Address - Country:US
Practice Address - Phone:210-334-3780
Practice Address - Fax:210-921-4167
Is Sole Proprietor?:No
Enumeration Date:2011-07-27
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17100124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist