Provider Demographics
NPI:1649470584
Name:LEWIS, KATHERINE (DMD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:2431 WEST MAIN STREET
Mailing Address - Street 2:SUITE 303
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-1251
Mailing Address - Country:US
Mailing Address - Phone:334-446-0428
Mailing Address - Fax:
Practice Address - Street 1:2431 W MAIN ST
Practice Address - Street 2:SUITE 303
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-1217
Practice Address - Country:US
Practice Address - Phone:334-446-0428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL55971223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics