Healthcare Provider Details

I. General information

NPI: 1295856706
Provider Name (Legal Business Name): ROBERT KENT BEWICK D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 NORTHGATE DR
MC MINNVILLE TN
37110-1450
US

IV. Provider business mailing address

241 NORTHGATE DR
MC MINNVILLE TN
37110-1450
US

V. Phone/Fax

Practice location:
  • Phone: 931-473-2782
  • Fax: 931-473-5882
Mailing address:
  • Phone: 931-473-2782
  • Fax: 931-473-5882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS3749
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: