Provider Demographics
NPI:1356599062
Name:HEWELL, KRISTYN CANDACE (DDS)
Entity type:Individual
Prefix:DR
First Name:KRISTYN
Middle Name:CANDACE
Last Name:HEWELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16661 21 MILE RD
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-2603
Mailing Address - Country:US
Mailing Address - Phone:586-286-0500
Mailing Address - Fax:
Practice Address - Street 1:16661 21 MILE RD
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-2603
Practice Address - Country:US
Practice Address - Phone:586-286-0500
Practice Address - Fax:586-286-6796
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010197861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice