Provider Demographics
NPI:1023220076
Name:LEWIS L BROWN DDS PA
Entity Type:Organization
Organization Name:LEWIS L BROWN DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:404-266-0111
Mailing Address - Street 1:3580 PIEDMONT RD NE
Mailing Address - Street 2:TUXEDO CENTER SUITE 113
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1506
Mailing Address - Country:US
Mailing Address - Phone:404-266-0111
Mailing Address - Fax:404-233-9759
Practice Address - Street 1:3580 PIEDMONT RD NE
Practice Address - Street 2:TUXEDO CENTER SUITE 113
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-1506
Practice Address - Country:US
Practice Address - Phone:404-266-0111
Practice Address - Fax:404-233-9759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA 9403122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty