Provider Demographics
NPI:1558434506
Name:SONYA D LEWIS DMD PA
Entity Type:Organization
Organization Name:SONYA D LEWIS DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-209-2534
Mailing Address - Street 1:10400 GRIFFIN RD
Mailing Address - Street 2:SUITE #303C
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33328-3337
Mailing Address - Country:US
Mailing Address - Phone:954-209-2534
Mailing Address - Fax:954-880-0488
Practice Address - Street 1:10400 GRIFFIN RD
Practice Address - Street 2:SUITE #303C
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33328-3337
Practice Address - Country:US
Practice Address - Phone:954-209-2534
Practice Address - Fax:954-880-0488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0012602122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U47399Medicare UPIN
FL69524Medicare ID - Type Unspecified