Provider Demographics
NPI:1275758112
Name:POWELL, LEWIS REED JR (DMD)
Entity Type:Individual
Prefix:MR
First Name:LEWIS
Middle Name:REED
Last Name:POWELL
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:33977 PLOWSHARE RD
Mailing Address - Street 2:
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595
Mailing Address - Country:US
Mailing Address - Phone:951-244-9005
Mailing Address - Fax:951-244-6135
Practice Address - Street 1:28410 OLD TOWNE FRONT ST
Practice Address - Street 2:SUITE #110 DENTURES 4 U AND GENERAL DENTISTRY 2
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590
Practice Address - Country:US
Practice Address - Phone:951-506-6555
Practice Address - Fax:951-694-6550
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24591122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist