Provider Demographics
NPI:1659669448
Name:LEWIS, RYAN CHARLES (DMD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:CHARLES
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 1:630 COMANCHE TRL STE A
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-1754
Mailing Address - Country:US
Mailing Address - Phone:502-226-1900
Mailing Address - Fax:502-226-1990
Practice Address - Street 1:630 COMANCHE TRL STE A
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-1754
Practice Address - Country:US
Practice Address - Phone:502-226-1900
Practice Address - Fax:502-226-1990
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY90571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice