Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 33489 | CA |
NPI | 1114096526 |
---|---|
Provider Name | Dr. John Francis Lewis |
First Address | Fair Oaks, CA 95628 |
Second Address | Sacramento, CA 95816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 08/07/2007 |