Provider Demographics
NPI:1487479887
Name:HEWLETT FAMILY DENTAL
Entity type:Organization
Organization Name:HEWLETT FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:HEWLETT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-633-2229
Mailing Address - Street 1:223 THE POINTE BLVD
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-7852
Mailing Address - Country:US
Mailing Address - Phone:502-487-0293
Mailing Address - Fax:502-633-7518
Practice Address - Street 1:223 THE POINTE BLVD
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-7852
Practice Address - Country:US
Practice Address - Phone:502-487-0293
Practice Address - Fax:502-633-7518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-20
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1952082927OtherNATALIE BOBAY
16296212677OtherSTEPHEN T. HEWLETT