Provider Demographics
NPI:1902975774
Name:HEWETT, SALLY JEAN (DDS)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:JEAN
Last Name:HEWETT
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 1:1509 FORT WARD HILL RD NE
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-2321
Mailing Address - Country:US
Mailing Address - Phone:206-780-7773
Mailing Address - Fax:
Practice Address - Street 1:1037 MADISON AVE N
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-1727
Practice Address - Country:US
Practice Address - Phone:206-842-9890
Practice Address - Fax:206-780-1982
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5000369Medicaid