Provider Demographics
NPI:1568566982
Name:LEWIS, REGINA L (DDS)
Entity Type:Individual
Prefix:DR
First Name:REGINA
Middle Name:L
Last Name:LEWIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:11455 FALLBROOK DR #202
Mailing Address - Street 2:REGINA L. LEWIS DDS. INC
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065
Mailing Address - Country:US
Mailing Address - Phone:281-890-7475
Mailing Address - Fax:281-890-4862
Practice Address - Street 1:11455 FALLBROOK DR #202
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065
Practice Address - Country:US
Practice Address - Phone:281-890-7475
Practice Address - Fax:281-890-4862
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX131961223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX090950901Medicaid