MEDICARE: RONALD A. 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
1	1223G0001X	General Practice Dentistry	DS3934	TN

General Provider Information

NPI Number	:	1043202112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD A. LEWIS DDS

Provider Business Mailing Address
First Line	:	525 RIVERGATE PKWY
Second Line	:	SUITE 1
City	:	GOODLETTSVILLE
State	:	TN
Zip	:	37072-2078
Country	:	US
Telephone Number	:	615-859-2276
Fax Number	:	615-859-2328

Provider Business Practice Location Address
First Line	:	525 RIVERGATE PKWY
Second Line	:	SUITE 1
City	:	GOODLETTSVILLE
State	:	TN
Zip	:	37072-2078
Country	:	US
Telephone Number	:	615-859-2276
Fax Number	:	615-859-2328

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	07/08/2007

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