Provider Demographics
NPI:1326640236
Name:KELSI LEWIS DDS PLLC
Entity Type:Organization
Organization Name:KELSI LEWIS DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:KELSI
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-771-1166
Mailing Address - Street 1:2002 CASA GRANDE DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78733-1609
Mailing Address - Country:US
Mailing Address - Phone:409-771-1166
Mailing Address - Fax:
Practice Address - Street 1:7717 SOUTHWEST PKWY # 250
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-8994
Practice Address - Country:US
Practice Address - Phone:409-771-1166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-15
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental