Individual
DR. SHANNON M. LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS, MS, PC
Contact information
Practice address
2900 N KELLY AVE, EDMOND, OK 73003-3233
(405) 330-5095
(405) 330-9945
Mailing address
2900 N. KELLY AVENUE, EDMOND, OK 73003
(405) 330-5095
(405) 330-9945
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
157
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200050900A
—
OK
Enumeration date
08/11/2005
Last updated
02/27/2014
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