Individual
TIMOTHY EUGENE LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
501 CLINIC RD, HANNIBAL, MO 63401
(573) 221-3360
(573) 221-1472
Mailing address
73 MEADOWS RD, HANNIBAL, MO 63401
(573) 221-1885
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DE015702
MO
122300000X
Dentist
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1004517
—
IL
Enumeration date
09/07/2006
Last updated
07/08/2007
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