Provider Demographics
NPI:1164970505
Name:LEWIS, BRANDI (DDS)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9205 EAGLE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MONT BELVIEU
Mailing Address - State:TX
Mailing Address - Zip Code:77523-5620
Mailing Address - Country:US
Mailing Address - Phone:832-479-0062
Mailing Address - Fax:832-479-0064
Practice Address - Street 1:9205 EAGLE DR STE 100
Practice Address - Street 2:
Practice Address - City:MONT BELVIEU
Practice Address - State:TX
Practice Address - Zip Code:77523-5620
Practice Address - Country:US
Practice Address - Phone:832-479-0062
Practice Address - Fax:832-479-0064
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-14
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD4608122300000X
CA652481223X0400X
TX384021223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist