Provider Demographics
NPI:1154662120
Name:BXPQ DENTAL KATHRYN A. LEWIS, D.D.S., LLC
Entity Type:Organization
Organization Name:BXPQ DENTAL KATHRYN A. LEWIS, D.D.S., LLC
Other - Org Name:DENTAL IMAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:419-887-5404
Mailing Address - Street 1:5850 WECKERLY RD
Mailing Address - Street 2:
Mailing Address - City:WHITEHOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43571-9510
Mailing Address - Country:US
Mailing Address - Phone:419-877-5404
Mailing Address - Fax:
Practice Address - Street 1:5850 WECKERLY RD
Practice Address - Street 2:
Practice Address - City:WHITEHOUSE
Practice Address - State:OH
Practice Address - Zip Code:43571-9510
Practice Address - Country:US
Practice Address - Phone:419-877-5404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-15
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30022405122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty