Provider Demographics
NPI:1356872634
Name:LEWIS, MATTHEW (DMD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:LEWIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 HICKMAN RD
Mailing Address - Street 2:APT. E
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-6721
Mailing Address - Country:US
Mailing Address - Phone:478-461-2006
Mailing Address - Fax:
Practice Address - Street 1:930 HICKMAN RD
Practice Address - Street 2:APT. E
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-6721
Practice Address - Country:US
Practice Address - Phone:478-461-2006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program