Individual
DR. LEW B. SAMPLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD, MS, PC
Contact information
Practice address
2014 DANVILLE PARK DR SW, DECATUR, AL 35603-1832
(256) 355-5255
Mailing address
2014 DANVILLE PARK DR SW, DECATUR, AL 35603-1832
(256) 355-5255
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
4668
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08038
BLUE CROSS PROVIDER
AL
01
—
4668
LICENSE NUMBER
AL
01
—
982261
UNITED CONCORDIA
AL
Enumeration date
04/10/2007
Last updated
07/08/2007
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