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Individual
DR. KENNETH DWAYNE LEWIS
Active
Individual
DR. KENNETH DWAYNE LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
15924
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D15924
BCBS
TX
Enumeration date
08/12/2006
Last updated
07/08/2007
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