Provider Demographics
NPI:1487765350
Name:LEWIS, ROBERT H (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:H
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 1:591 HORSEBARN RD
Mailing Address - Street 2:#100
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8780
Mailing Address - Country:US
Mailing Address - Phone:479-636-3979
Mailing Address - Fax:479-636-0800
Practice Address - Street 1:591 HORSEBARN RD
Practice Address - Street 2:#100
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8780
Practice Address - Country:US
Practice Address - Phone:479-636-3979
Practice Address - Fax:479-636-0800
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR311223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5ZZ04OtherBCBS MEDICAL
AR58892Medicare PIN
T-20488Medicare UPIN
AR5ZZ04OtherBCBS MEDICAL