Healthcare Provider Details

I. General information

NPI: 1043442437
Provider Name (Legal Business Name): TERRENCE O'NEAL LEWIS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2009
Last Update Date: 05/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US ARMY DENTAC BAVARIA UNIT 28038
APO AE
09112
US

IV. Provider business mailing address

US ARMY DENTAC BAVARIA UNIT 28038
APO AE
09112
US

V. Phone/Fax

Practice location:
  • Phone: 314-590-3980
  • Fax:
Mailing address:
  • Phone: 314-590-3980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number29592
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: