Provider Demographics
NPI:1679628903
Name:CASE, LEWIS SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:SCOTT
Last Name:CASE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3008
Mailing Address - Country:US
Mailing Address - Phone:313-563-2632
Mailing Address - Fax:313-563-3821
Practice Address - Street 1:2250 MONROE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3008
Practice Address - Country:US
Practice Address - Phone:313-563-2632
Practice Address - Fax:313-563-3821
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI161381223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health