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General NPI Number Information
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NPI Number | 1891797692
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Entity Type | Individual
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Provider Name | SHANNON M. LEWIS DDS, MS, PC
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Gender | Female
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Dates
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Enumeration Date | 08/11/2005
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Last Update Date | 02/27/2014
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Provider Practice Location Address
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Address Line | 2900 N KELLY AVE
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City | EDMOND
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State | OK
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Zip | 73003-3233
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Country | US
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Telephone | 405-330-5095
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Fax | 405-330-9945
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Provider Business Mailing Address
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Address Line | 2900 N. KELLY AVENUE
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City | EDMOND
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State | OK
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Zip | 73003
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Country | US
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Telephone | 405-330-5095
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Fax | 405-330-9945
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 157
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License Number State | OK
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