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General NPI Number Information
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NPI Number | 1336671304
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Entity Type | Individual
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Provider Name | KASSIDY LEWIS DMD
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Gender | Female
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Dates
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Enumeration Date | 03/29/2017
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Last Update Date | 02/08/2021
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Provider Practice Location Address
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Address Line | 10 DEER CROSSING TRCE
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City | BLAIRSVILLE
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State | GA
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Zip | 30512-1496
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Country | US
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Telephone | 706-445-1880
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Fax |
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Provider Business Mailing Address
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Address Line | 458 RIVER RIDGE DR
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City | BLUE RIDGE
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State | GA
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Zip | 30513-6595
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Country | US
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Telephone | 770-324-2821
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN015588
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License Number State | GA
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