Provider Demographics
NPI:1083609424
Name:LEWIS, RICHARD S (DMD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:S
Last Name:LEWIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-2543
Mailing Address - Country:US
Mailing Address - Phone:781-272-5890
Mailing Address - Fax:781-272-6552
Practice Address - Street 1:281 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-2543
Practice Address - Country:US
Practice Address - Phone:781-272-5890
Practice Address - Fax:781-272-6552
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
MA128971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice