Provider Demographics
NPI:1689664880
Name:LEWIS, BRIAN DAVID
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:DAVID
Last Name:LEWIS
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:BRIAN
Other - Middle Name:DAVID
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:791 BLOSSOM RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610-1907
Mailing Address - Country:US
Mailing Address - Phone:585-482-1170
Mailing Address - Fax:585-482-5921
Practice Address - Street 1:791 BLOSSOM RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14610-1907
Practice Address - Country:US
Practice Address - Phone:585-482-1170
Practice Address - Fax:585-482-5921
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032156122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist