Active NPI
Wendell Arden Lewis, D.D.S., M.S.D.
- Orthodontics and Dentofacial Orthopedics Dentistry
- Joplin, MO
National Provider Identifier
1750605812
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 11753
- Practice address
- 3202 McIntosh Circle Drive
LL03
Joplin, MO 64804 - Phone
- (417) 623-1894
- Fax
- (417) 623-0163
- NPI assigned
- Mar 18, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 11753 | MO | Primary |
Addresses
Primary practice location
3202 McIntosh Circle Drive
LL03
Joplin, MO 64804
Mailing address
3202 McIntosh Circle Drive
LL03
Joplin, MO 64804
Phone (417) 623-1894
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11753 | MO | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1268870400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1268870400000",
"number": "1750605812",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3202 MCINTOSH CIRCLE DRIVE",
"address_2": "LL03",
"city": "JOPLIN",
"state": "MO",
"postal_code": "64804",
"telephone_number": "417-623-1894",
"fax_number": "417-623-0163"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3202 MCINTOSH CIRCLE DRIVE",
"address_2": "LL03",
"city": "JOPLIN",
"state": "MO",
"postal_code": "64804",
"telephone_number": "417-623-1894",
"fax_number": "417-623-0163"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEWIS",
"first_name": "WENDELL",
"middle_name": "ARDEN",
"name_prefix": "Dr.",
"credential": "D.D.S., M.S.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-03-18",
"last_updated": "2010-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "MO",
"license": "11753",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Joplin, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.