Provider Demographics
NPI:1376953737
Name:LEWIS, PAUL ROBERT (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ROBERT
Last Name:LEWIS
Suffix:
Gender:M
Credentials:DDS, MD
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Mailing Address - Street 1:591 S HORSEBARN RD
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8710
Mailing Address - Country:US
Mailing Address - Phone:479-636-3979
Mailing Address - Fax:479-636-0800
Practice Address - Street 1:591 S HORSEBARN RD
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8710
Practice Address - Country:US
Practice Address - Phone:479-636-3979
Practice Address - Fax:479-636-0800
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AR43381223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery