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NPI Code Detail

MEDICARE: DR. DUANE EDGAR LEWIS DDS

MEDICARE: DR. DUANE EDGAR LEWIS DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist30021606OH
2122300000XDentist5747KY

General Provider Information

NPI Number : 1639273774
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DUANE EDGAR LEWIS DDS
Provider Business Mailing Address
First Line : 3101 BURNET AVEUNE
Second Line :
City : CINCINNATI
State : OH
Zip : 45229-3014
Country : US
Telephone Number : 513-357-7289
Fax Number :
Provider Business Practice Location Address
First Line : 3917 SPRING GROVE AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45223-3302
Country : US
Telephone Number : 513-357-7289
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/11/2006
Last Update Date : 07/12/2012

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