Basic Information
| Provider Information | |||||||||
| NPI: | 1619976354 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | APPEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6350 W A J HWY | ||||||||
| Address2: | DEPARTMENT 100 | ||||||||
| City: | TALBOTT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378778605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003553565 | ||||||||
| FaxNumber: | 4237142355 | ||||||||
| Practice Location | |||||||||
| Address1: | 4330 MAYNARDVILLE HWY | ||||||||
| Address2: | |||||||||
| City: | MAYNARDVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378073618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8659923849 | ||||||||
| FaxNumber: | 8659925166 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2005 | ||||||||
| LastUpdateDate: | 01/18/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | DS4816 | TN | Y | Dental Providers | Dentist | General Practice |
No ID Information.