Healthcare Provider Details

I. General information

NPI: 1932387834
Provider Name (Legal Business Name): DAVID LEE EWING D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2008
Last Update Date: 11/15/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 W HAYWARD DR
MT VERNON MO
65712
US

IV. Provider business mailing address

1050 W HAYWARD DR
MT VERNON MO
65712
US

V. Phone/Fax

Practice location:
  • Phone: 816-922-7600
  • Fax:
Mailing address:
  • Phone: 816-923-5800
  • Fax: 417-466-4081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2008002034
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: