Individual
MRS. PENNIE SUE LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
5747 BLAINE SE, KENTWOOD, MI 49508
(616) 455-2467
Mailing address
5747 BLAINE SE, KENTWOOD, MI 49508
(616) 455-2467
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
#4114
MI
Other
Enumeration date
06/21/2010
Last updated
06/21/2010
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