Individual
JUSTIN EWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
3501 N BUTLER AVE, SUITE 104, FARMINGTON, NM 87401-6429
(505) 564-4470
(505) 325-9707
Mailing address
3501 N BUTLER AVE, SUITE 104, FARMINGTON, NM 87401-6429
(505) 564-4470
(505) 325-9707
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DD4518
NM
Other
Enumeration date
06/05/2016
Last updated
06/05/2016
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