Provider Demographics
NPI:1386912715
Name:MCEWAN, ROBIN S (DDS, MS)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:S
Last Name:MCEWAN
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2277 MICHAEL DR
Mailing Address - Street 2:1
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-3392
Mailing Address - Country:US
Mailing Address - Phone:805-498-1006
Mailing Address - Fax:805-498-3359
Practice Address - Street 1:2277 MICHAEL DR
Practice Address - Street 2:1
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-3392
Practice Address - Country:US
Practice Address - Phone:805-498-1006
Practice Address - Fax:805-498-3359
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA354311223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics