Provider Demographics
NPI:1871536029
Name:LEWIS, GARRY L (DDS)
Entity type:Individual
Prefix:DR
First Name:GARRY
Middle Name:L
Last Name:LEWIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNDSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26041-1907
Mailing Address - Country:US
Mailing Address - Phone:304-845-5651
Mailing Address - Fax:304-845-5707
Practice Address - Street 1:807 5TH ST
Practice Address - Street 2:
Practice Address - City:MOUNDSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26041-1907
Practice Address - Country:US
Practice Address - Phone:304-845-5651
Practice Address - Fax:304-845-5707
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV23681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice