Provider Demographics
NPI:1508069410
Name:LEWIS, DAVID MILTON (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MILTON
Last Name:LEWIS
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 1:4350 MARCONI AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-4310
Mailing Address - Country:US
Mailing Address - Phone:916-487-7148
Mailing Address - Fax:916-487-7148
Practice Address - Street 1:4350 MARCONI AVE STE 100
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-4310
Practice Address - Country:US
Practice Address - Phone:916-487-7148
Practice Address - Fax:916-487-7148
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA31489122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist