Provider Demographics
NPI:1477155646
Name:CHAD S LEWISON, DDS,PC
Entity Type:Organization
Organization Name:CHAD S LEWISON, DDS,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CDA
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:LEMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-764-3179
Mailing Address - Street 1:1110 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:SD
Mailing Address - Zip Code:57013-1543
Mailing Address - Country:US
Mailing Address - Phone:605-764-3179
Mailing Address - Fax:605-764-3181
Practice Address - Street 1:1110 W 5TH ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:SD
Practice Address - Zip Code:57013-1543
Practice Address - Country:US
Practice Address - Phone:605-764-3179
Practice Address - Fax:605-764-3181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental