Provider Demographics
NPI:1063548022
Name:MCEWAN, JACK B (DDS)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:B
Last Name:MCEWAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1650 COSHOCTON AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-1547
Mailing Address - Country:US
Mailing Address - Phone:740-392-2000
Mailing Address - Fax:740-392-2002
Practice Address - Street 1:1650 COSHOCTON AVE
Practice Address - Street 2:SUITE D
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-1547
Practice Address - Country:US
Practice Address - Phone:740-392-2000
Practice Address - Fax:740-392-2002
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0224561223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery