Provider Demographics
NPI:1225011323
Name:SUMNER, LEWIS TYLER (DMD)
Entity Type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:TYLER
Last Name:SUMNER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 ELLA ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-4811
Mailing Address - Country:US
Mailing Address - Phone:864-226-7503
Mailing Address - Fax:864-225-4937
Practice Address - Street 1:1209 ELLA ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-4811
Practice Address - Country:US
Practice Address - Phone:864-226-7503
Practice Address - Fax:864-225-4937
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC34831223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX3483Medicaid
SCZX3483Medicaid
SCU86861Medicare UPIN