Basic Information
| Provider Information | |||||||||
| NPI: | 1952756793 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEWEY | ||||||||
| FirstName: | FERN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | R.D.H. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WESLEY | ||||||||
| OtherFirstName: | FERN | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | R.D.H. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 103 MEDICINE WAY | ||||||||
| Address2: | |||||||||
| City: | PERIDOT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9284751400 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 103 MEDICINE WAY | ||||||||
| Address2: | |||||||||
| City: | PERIDOT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9284751400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2016 | ||||||||
| LastUpdateDate: | 04/29/2016 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 124Q00000X | 6912 | AZ | Y | Dental Providers | Dental Hygienist |
No ID Information.