Provider Demographics
NPI:1639273774
Name:LEWIS, DUANE EDGAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:DUANE
Middle Name:EDGAR
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 1:3101 BURNET AVEUNE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3014
Mailing Address - Country:US
Mailing Address - Phone:513-357-7289
Mailing Address - Fax:
Practice Address - Street 1:3917 SPRING GROVE AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45223-3302
Practice Address - Country:US
Practice Address - Phone:513-357-7289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30021606122300000X
KY5747122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist