Provider Demographics
NPI:1295824597
Name:THOMAS, LEWIS MAXWELL JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:MAXWELL
Last Name:THOMAS
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:LEWIS
Other - Middle Name:M
Other - Last Name:THOMAS
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 1650
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35594
Mailing Address - Country:US
Mailing Address - Phone:205-487-2191
Mailing Address - Fax:205-487-2191
Practice Address - Street 1:170 CITY HALL STREET
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:AL
Practice Address - Zip Code:35594
Practice Address - Country:US
Practice Address - Phone:205-487-2191
Practice Address - Fax:205-487-2191
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL3201122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist