Provider Demographics
NPI:1376752055
Name:LEWIS, GAYLORD ROSS (DDS)
Entity Type:Individual
Prefix:DR
First Name:GAYLORD
Middle Name:ROSS
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 1:35 W ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-5545
Mailing Address - Country:US
Mailing Address - Phone:956-541-2181
Mailing Address - Fax:956-541-3077
Practice Address - Street 1:35 W ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-5545
Practice Address - Country:US
Practice Address - Phone:956-541-2181
Practice Address - Fax:956-541-3077
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice