Provider Demographics
NPI:1598978629
Name:LEWIS, MICHAEL R (DMD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
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 1:14 FRANKLIN ST
Mailing Address - Street 2:820 TEMPLE BUILDING
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14604
Mailing Address - Country:US
Mailing Address - Phone:585-325-2474
Mailing Address - Fax:585-325-2715
Practice Address - Street 1:14 FRANKLIN ST
Practice Address - Street 2:820 TEMPLE BUILDING
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14604
Practice Address - Country:US
Practice Address - Phone:585-325-2474
Practice Address - Fax:585-325-2715
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030516122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist