Provider Demographics
NPI:1992971915
Name:JEWELL AND ASSOCIATES, PLLC
Entity type:Organization
Organization Name:JEWELL AND ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILSON
Authorized Official - Middle Name:O'KELLY
Authorized Official - Last Name:JEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:910-791-2401
Mailing Address - Street 1:218 PINE GROVE DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-5160
Mailing Address - Country:US
Mailing Address - Phone:910-791-2401
Mailing Address - Fax:910-791-2408
Practice Address - Street 1:218 PINE GROVE DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-5160
Practice Address - Country:US
Practice Address - Phone:910-791-2401
Practice Address - Fax:910-791-2408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC64831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty