Provider Demographics
NPI:1588683833
Name:LEWIS, TRACY L (DMD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:L
Last Name:LEWIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 COURT ST
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13901-3300
Mailing Address - Country:US
Mailing Address - Phone:607-773-3131
Mailing Address - Fax:
Practice Address - Street 1:89 COURT ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13901-3300
Practice Address - Country:US
Practice Address - Phone:607-773-3131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048133122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist