Provider Demographics
NPI:1447746706
Name:LEWIS, JOHN CURTIS TERRELL (DMD)
Entity Type:Individual
Prefix:
First Name:JOHN CURTIS
Middle Name:TERRELL
Last Name:LEWIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2590 TAHOE DR
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-1860
Mailing Address - Country:US
Mailing Address - Phone:803-469-3555
Mailing Address - Fax:803-469-3515
Practice Address - Street 1:2590 TAHOE DR
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-1860
Practice Address - Country:US
Practice Address - Phone:803-469-3555
Practice Address - Fax:803-469-3515
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC91771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice