Individual
KASSIDY LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
10 DEER CROSSING TRCE, BLAIRSVILLE, GA 30512-1496
(706) 445-1880
Mailing address
458 RIVER RIDGE DR, BLUE RIDGE, GA 30513-6595
(770) 324-2821
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN015588
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/29/2017
Last updated
02/08/2021
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