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NPI Code Detail

MEDICARE: LEWIS ORTHODONTICS

MEDICARE: LEWIS ORTHODONTICS
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
11223X0400XOrthodontics and Dentofacial Orthopedics Dentistry157OK

General Provider Information

NPI Number : 1588838403
Entity Type Code : Organization
Provider Name (Legal Business Name) : LEWIS ORTHODONTICS
Provider Business Mailing Address
First Line : 2900 N KELLY AVE
Second Line :
City : EDMOND
State : OK
Zip : 73003-3233
Country : US
Telephone Number : 405-330-5095
Fax Number : 405-330-9945
Provider Business Practice Location Address
First Line : 2900 N KELLY AVE
Second Line :
City : EDMOND
State : OK
Zip : 73003-3233
Country : US
Telephone Number : 405-330-5095
Fax Number : 405-330-9945
Authorized Official
Title or Position : DOCTOR
Name : DR. SHANNON M. LEWIS
Credential : DDS, MS
Telephone Number : 405-330-5095
Provider Enumeration Date : 04/22/2008
Last Update Date : 04/22/2008

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Directions to “LEWIS ORTHODONTICS ” Practice Location

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