Individual
KEVIN L LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
3900 BRISTOL HWY # B-14, JOHNSON CITY, TN 37601-1378
(423) 282-1842
Mailing address
3900 BRISTOL HWY # B-14, JOHNSON CITY, TN 37601-1378
(423) 282-1842
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS007408
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4004301
BLUE CROSS BLUE SHIELD
TN
01
—
451884
UNITED CONCORDIA
TN
Enumeration date
12/29/2006
Last updated
07/08/2007
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