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General NPI Number Information
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NPI Number | 1336709666
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Entity Type | Individual
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Provider Name | ERIC E BEWLEY CDT
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Gender | Male
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Dates
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Enumeration Date | 06/18/2019
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Last Update Date | 06/18/2019
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Provider Practice Location Address
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Address Line | 2094 RICHARD ST
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City | PRESCOTT
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State | AZ
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Zip | 86301-1047
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Country | US
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Telephone | 928-710-7212
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Fax |
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Provider Business Mailing Address
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Address Line | 2094 RICHARD ST
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City | PRESCOTT
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State | AZ
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Zip | 86301-1047
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Country | US
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Telephone | 928-710-7212
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 126900000X
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Taxonomy Name | Dental Laboratory Technician
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License Number |
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License Number State |
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