Provider Demographics
NPI:1043202112
Name:LEWIS, RONALD A (DDS)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:A
Last Name:LEWIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 RIVERGATE PKWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-2078
Mailing Address - Country:US
Mailing Address - Phone:615-859-2276
Mailing Address - Fax:615-859-2328
Practice Address - Street 1:525 RIVERGATE PKWY
Practice Address - Street 2:SUITE 1
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-2078
Practice Address - Country:US
Practice Address - Phone:615-859-2276
Practice Address - Fax:615-859-2328
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS39341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice