Individual
JEREMY ALLEN LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
4307 3RD AVE, MARIANNA, FL 32446-2177
(850) 526-4220
Mailing address
4307 3RD AVE, MARIANNA, FL 32446-2177
(850) 526-4220
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN17076
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
076091900
—
FL
01
—
DC17076
DENTAL LICENSE
FL
Enumeration date
12/09/2005
Last updated
03/28/2017
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