Provider Demographics
NPI:1295833903
Name:WAYT, LEWIS R (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:R
Last Name:WAYT
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 1:7710 SIGHTSEEING RD
Mailing Address - Street 2:BLDG 2826
Mailing Address - City:FORT BENNING
Mailing Address - State:GA
Mailing Address - Zip Code:31905-3764
Mailing Address - Country:US
Mailing Address - Phone:706-544-3103
Mailing Address - Fax:
Practice Address - Street 1:7710 SIGHTSEEING RD
Practice Address - Street 2:BLDG 2826
Practice Address - City:FORT BENNING
Practice Address - State:GA
Practice Address - Zip Code:31905-3764
Practice Address - Country:US
Practice Address - Phone:706-544-3103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5617122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist