Provider Demographics
NPI:1952752180
Name:TEW, DEREK (DDS)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:
Last Name:TEW
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:DEREK
Other - Middle Name:ELDEN
Other - Last Name:TEW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1012 S 40TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3804
Mailing Address - Country:US
Mailing Address - Phone:509-575-0419
Mailing Address - Fax:509-966-6595
Practice Address - Street 1:1012 S 40TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3804
Practice Address - Country:US
Practice Address - Phone:509-575-0419
Practice Address - Fax:509-966-6595
Is Sole Proprietor?:No
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60664663122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist