Provider Demographics
NPI:1164900031
Name:DEWENTER, ALYSSA CATHERINE (DDS)
Entity type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:CATHERINE
Last Name:DEWENTER
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 1:37512 MELROSE DR
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-7726
Mailing Address - Country:US
Mailing Address - Phone:425-233-2545
Mailing Address - Fax:
Practice Address - Street 1:67760 E PALM CANYON DR
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-5472
Practice Address - Country:US
Practice Address - Phone:760-688-7653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1029311223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice