Provider Demographics
NPI:1225000821
Name:LEWIS, DAVIS MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVIS
Middle Name:MICHAEL
Last Name:LEWIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 30TH ST NE
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75462-2802
Mailing Address - Country:US
Mailing Address - Phone:903-784-5103
Mailing Address - Fax:
Practice Address - Street 1:902 E LINCOLN RD
Practice Address - Street 2:
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745-7337
Practice Address - Country:US
Practice Address - Phone:580-286-2600
Practice Address - Fax:580-286-1172
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist