Provider Demographics
NPI:1740409085
Name:LEWIS, MILLER BENJAMIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MILLER
Middle Name:BENJAMIN
Last Name:LEWIS
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 1:801 N PITT ST
Mailing Address - Street 2:111
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-1765
Mailing Address - Country:US
Mailing Address - Phone:703-549-1288
Mailing Address - Fax:703-549-1242
Practice Address - Street 1:801 N PITT ST
Practice Address - Street 2:111
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-1765
Practice Address - Country:US
Practice Address - Phone:703-549-1288
Practice Address - Fax:703-549-1242
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401005355122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist