Provider Demographics
NPI:1316334071
Name:JEWETT, JOHN MARSHALL (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MARSHALL
Last Name:JEWETT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2333 KNOB CREEK RD STE 10
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2007
Mailing Address - Country:US
Mailing Address - Phone:423-854-8830
Mailing Address - Fax:423-854-8741
Practice Address - Street 1:2333 KNOB CREEK RD STE 10
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604
Practice Address - Country:US
Practice Address - Phone:423-854-8830
Practice Address - Fax:423-854-8741
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000105951223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics