Healthcare Provider Details

I. General information

NPI: 1376953737
Provider Name (Legal Business Name): PAUL ROBERT LEWIS DDS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2014
Last Update Date: 07/14/2020
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

591 S HORSEBARN RD
ROGERS AR
72758-8710
US

IV. Provider business mailing address

591 S HORSEBARN RD
ROGERS AR
72758-8710
US

V. Phone/Fax

Practice location:
  • Phone: 479-636-3979
  • Fax: 479-636-0800
Mailing address:
  • Phone: 479-636-3979
  • Fax: 479-636-0800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number4338
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: