Provider Demographics
NPI:1336709666
Name:BEWLEY, ERIC E (CDT)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:E
Last Name:BEWLEY
Suffix:
Gender:M
Credentials:CDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2094 RICHARD ST
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1047
Mailing Address - Country:US
Mailing Address - Phone:928-710-7212
Mailing Address - Fax:
Practice Address - Street 1:2094 RICHARD ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1047
Practice Address - Country:US
Practice Address - Phone:928-710-7212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126900000XDental ProvidersDental Laboratory Technician