Provider Demographics
NPI:1275799058
Name:O'SHEA, LEWIS BENJAMIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:BENJAMIN
Last Name:O'SHEA
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 1:19 CAROLINE DR
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-8345
Mailing Address - Country:US
Mailing Address - Phone:631-499-5825
Mailing Address - Fax:
Practice Address - Street 1:19 CAROLINE DR
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-8345
Practice Address - Country:US
Practice Address - Phone:631-499-5825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0539691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice