Provider Demographics
NPI:1619954476
Name:LEWIS, WILLIAM J (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
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:PO BOX 828
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:KS
Mailing Address - Zip Code:67878
Mailing Address - Country:US
Mailing Address - Phone:620-384-5252
Mailing Address - Fax:620-384-5301
Practice Address - Street 1:405 N MAIN
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:KS
Practice Address - Zip Code:67878
Practice Address - Country:US
Practice Address - Phone:620-384-5252
Practice Address - Fax:620-384-5301
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS55671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS8315OtherBCBS