Provider Demographics
NPI:1336317692
Name:LEWIS, DINE AND ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:LEWIS, DINE AND ASSOCIATES, P.A.
Other - Org Name:LEWIS FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:BOYD
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:910-488-0518
Mailing Address - Street 1:4140 RAMSEY ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-7672
Mailing Address - Country:US
Mailing Address - Phone:910-488-0518
Mailing Address - Fax:910-630-2432
Practice Address - Street 1:4140 RAMSEY ST STE 104
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-7658
Practice Address - Country:US
Practice Address - Phone:910-488-0518
Practice Address - Fax:910-630-2432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5029122300000X
1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty