Provider Demographics
NPI:1043363138
Name:WILLIAM L LEWIS D.D.S.,P.A.
Entity Type:Organization
Organization Name:WILLIAM L LEWIS D.D.S.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNERCEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:507-789-6211
Mailing Address - Street 1:216 FOREST ST
Mailing Address - Street 2:
Mailing Address - City:KENYON
Mailing Address - State:MN
Mailing Address - Zip Code:55946-1151
Mailing Address - Country:US
Mailing Address - Phone:507-789-6211
Mailing Address - Fax:507-789-6210
Practice Address - Street 1:216 FOREST ST
Practice Address - Street 2:
Practice Address - City:KENYON
Practice Address - State:MN
Practice Address - Zip Code:55946-1151
Practice Address - Country:US
Practice Address - Phone:507-789-6211
Practice Address - Fax:507-789-6210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND 100851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty