Organization
MAUMELLE FAMILY DENTISTRY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD H LEWIS DDS (OWNER)
(501) 851-1414
Entity
Organization
Contact information
Practice address
1701 CLUB MANOR DR STE 4, MAUMELLE, AR 72113-7401
(501) 851-1414
Mailing address
1701 CLUB MANOR DR STE 4, MAUMELLE, AR 72113-7401
(501) 851-1414
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2244
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104718608
—
AR
Enumeration date
09/18/2017
Last updated
09/18/2017
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