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NPI Code Detail

MEDICARE: PHOEBY K LEWIS DMD

MEDICARE: PHOEBY K LEWIS DMD
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
11223G0001XGeneral Practice DentistryDN011094GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
281635OTHERGAUNITED CONC.
30007529OTHERGADORAL
4100678OTHERGAAVESIS

General Provider Information

NPI Number : 1154364396
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHOEBY K LEWIS DMD
Provider Business Mailing Address
First Line : 201 W 8TH ST
Second Line : SUITE 810
City : PUEBLO
State : CO
Zip : 81003-3038
Country : US
Telephone Number : 716-562-4447
Fax Number :
Provider Business Practice Location Address
First Line : 1536 EISENHOWER PKWY
Second Line :
City : MACON
State : GA
Zip : 31206-3130
Country : US
Telephone Number : 478-781-4333
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2006
Last Update Date : 05/18/2010

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Directions to “ PHOEBY K LEWIS DMD” Practice Location

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