Provider Demographics
NPI:1013371236
Name:JEFFREY A. LEWIS, D.D.S., P.C.
Entity Type:Organization
Organization Name:JEFFREY A. LEWIS, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-781-1733
Mailing Address - Street 1:6060 RICHMOND AVE
Mailing Address - Street 2:SUITE 340
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-6227
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6060 RICHMOND AVE
Practice Address - Street 2:SUITE 340
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-6227
Practice Address - Country:US
Practice Address - Phone:713-781-1733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX123711223G0001X
TX228451223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty