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General NPI Number Information
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NPI Number | 1497318471
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Entity Type | Organization
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Legal Business Name | JOHN MARSHALL JEWETT DMD PLLC
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Dates
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Enumeration Date | 04/16/2019
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Last Update Date | 04/16/2019
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Provider Practice Location Address
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Address Line | 2333 KNOB CREEK RD STE 10
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City | JOHNSON CITY
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State | TN
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Zip | 37604-2007
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Country | US
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Telephone | 423-854-8830
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Fax | 423-854-8741
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Provider Business Mailing Address
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Address Line | 2333 KNOB CREEK RD STE 10
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City | JOHNSON CITY
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State | TN
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Zip | 37604-2007
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Country | US
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Telephone | 423-854-8830
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Fax | 423-854-8741
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN MARSHALL JEWETT
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Credential | DMD
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Telephone | 423-384-2240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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