Active NPI
Walter Glenn Lewis, DDS
- Orthodontics and Dentofacial Orthopedics Dentistry
- Marietta, GA
National Provider Identifier
1780848788
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- DN009753
- Practice address
- 2526 Shallowford Rd
Suite a
Marietta, GA 30066-3053 - Phone
- (770) 924-7826
- Fax
- (770) 924-2822
- NPI assigned
- Jul 18, 2008
- 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 | DN009753 | GA | Primary |
Addresses
Primary practice location
2526 Shallowford Rd
Suite a
Marietta, GA 30066-3053
Mailing address
2526 Shallowford Rd
Suite a
Marietta, GA 30066-3053
Phone (770) 924-7826
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 |
|---|---|---|---|
| DN009753 | GA | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1216339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1216339200000",
"number": "1780848788",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2526 SHALLOWFORD RD",
"address_2": "SUITE A",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300663053",
"telephone_number": "770-924-7826",
"fax_number": "770-924-2822"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2526 SHALLOWFORD RD",
"address_2": "SUITE A",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300663053",
"telephone_number": "770-924-7826",
"fax_number": "770-924-2822"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEWIS",
"first_name": "WALTER",
"middle_name": "GLENN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-07-18",
"last_updated": "2008-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "GA",
"license": "DN009753",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marietta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.