Provider Demographics
NPI:1750881397
Name:JEWELL, ABBY (DDS)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:
Last Name:JEWELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 NW BENT TREE DR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64081-1836
Mailing Address - Country:US
Mailing Address - Phone:816-560-8351
Mailing Address - Fax:
Practice Address - Street 1:2070 NW LOWENSTEIN DR STE C
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081-1903
Practice Address - Country:US
Practice Address - Phone:816-287-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND140841223S0112X
MN----1223S0112X
MO20230058351223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery