Provider Demographics
NPI:1457353419
Name:LEWIS, ELIZABETH TOWNLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:TOWNLEY
Last Name:LEWIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3523 VINTAGE TRAIL
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189
Mailing Address - Country:US
Mailing Address - Phone:678-445-3426
Mailing Address - Fax:
Practice Address - Street 1:7768 CUMMING HIGHWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114
Practice Address - Country:US
Practice Address - Phone:678-493-2204
Practice Address - Fax:678-493-2275
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11977122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist