Provider Demographics
NPI:1821000308
Name:LEWIS, GUY M (DDS)
Entity Type:Individual
Prefix:DR
First Name:GUY
Middle Name:M
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 1:4800 W PANTHER CREEK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-2568
Mailing Address - Country:US
Mailing Address - Phone:281-367-6465
Mailing Address - Fax:281-367-5516
Practice Address - Street 1:4800 W PANTHER CREEK DR
Practice Address - Street 2:SUITE 200
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-2563
Practice Address - Country:US
Practice Address - Phone:281-367-6465
Practice Address - Fax:281-367-5516
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14213122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX14213OtherDENTAL ID