Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 6925 | SC |
NPI | 1255631214 |
---|---|
Provider Name | Dr. Steven Gordon Lewis |
First Address | Fort Mill, SC 29715-8408 |
Second Address | Fort Mill, SC 29715-8408 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2010 |
Last Update Date | 03/07/2014 |