Provider Demographics
NPI:1558495341
Name:LEWIS, MONICA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27268 PEMBRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-3671
Mailing Address - Country:US
Mailing Address - Phone:248-478-7838
Mailing Address - Fax:
Practice Address - Street 1:16800 W 12 MILE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2108
Practice Address - Country:US
Practice Address - Phone:248-443-5371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI152151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice