Bewick Dental Corp
Dentist, General Practice in Portage, IN. Organization (NPI-2).
NPI number1295930196
StatusActive
Last updated in NPPESAug 22, 2020
Details
- NPI
- 1295930196
- Entity type
- Organization (NPI-2)
- Legal business name
- Bewick Dental Corp
- Organization subpart
- No
- Enumeration date
- Jun 19, 2007
- Last updated
- Aug 22, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | 12008296A | IN | Yes |
Practice location
3410 Willowcreek RdPortage, IN 46368-5089
Phone 219-762-5288 · Fax 219-763-3369
Mailing address
3410 Willowcreek RdPortage, IN 46368-5089
Phone 219-762-5288 · Fax 219-763-3369
Authorized official
Robert Kent Bewick
Owner
2197625288
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