Provider Demographics
NPI:1649488446
Name:LEWIS, MILTON LANARD (DDS)
Entity type:Individual
Prefix:
First Name:MILTON
Middle Name:LANARD
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 1:1988 SW PANTHER TRCE
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-4851
Mailing Address - Country:US
Mailing Address - Phone:305-801-0127
Mailing Address - Fax:
Practice Address - Street 1:1988 SW PANTHER TRCE
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-4851
Practice Address - Country:US
Practice Address - Phone:305-801-0127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190245751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice