Individual
TIFFANY THAO LEE LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
4023 NW 10TH ST, OKLAHOMA CITY, OK 73107-6038
(405) 632-6688
Mailing address
2212 WATERFORD LN, YUKON, OK 73099-4604
(405) 308-1657
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6399
OK
Other
Enumeration date
09/21/2012
Last updated
08/30/2022
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