Individual
DR. RICHARD D. FEWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.,M.S.
Contact information
Practice address
205 S JACKSON ST, TULLAHOMA, TN 37388-4426
(931) 455-0146
(931) 393-3863
Mailing address
205 S JACKSON ST, TULLAHOMA, TN 37388-4426
(931) 455-0146
(931) 393-3863
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
261
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0014167
DORAL DENTAL
—
01
—
0136409
BLUE CROSS BLUE SHIELD
TN
01
—
835940
UNITED CONCORDIA
—
Enumeration date
10/21/2005
Last updated
07/08/2007
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