Provider Demographics
NPI:1043385107
Name:J DENNIS LEWIS DDS PC
Entity Type:Organization
Organization Name:J DENNIS LEWIS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:C
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:CDA
Authorized Official - Phone:714-990-8891
Mailing Address - Street 1:410 WEST CENTRAL AVE
Mailing Address - Street 2:#201
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821
Mailing Address - Country:US
Mailing Address - Phone:714-990-8891
Mailing Address - Fax:714-990-1649
Practice Address - Street 1:1770 E LAMBERT RD
Practice Address - Street 2:#220
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-4372
Practice Address - Country:US
Practice Address - Phone:714-990-8891
Practice Address - Fax:714-990-1649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27162122300000X
27162122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty