Provider Demographics
NPI:1750605812
Name:LEWIS, WENDELL ARDEN (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:WENDELL
Middle Name:ARDEN
Last Name:LEWIS
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Gender:M
Credentials:DDS, MSD
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Mailing Address - Street 1:3202 MCINTOSH CIRCLE DRIVE
Mailing Address - Street 2:LL03
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804
Mailing Address - Country:US
Mailing Address - Phone:417-623-1894
Mailing Address - Fax:417-623-0163
Practice Address - Street 1:3202 MCINTOSH CIRCLE DRIVE
Practice Address - Street 2:LL03
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804
Practice Address - Country:US
Practice Address - Phone:417-623-1894
Practice Address - Fax:417-623-0163
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO117531223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics