Provider Demographics
NPI:1760604490
Name:BROWN, LEWIS L (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:L
Last Name:BROWN
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 1:3580 PIEDMONT RD NE
Mailing Address - Street 2:SUITE 113
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1506
Mailing Address - Country:US
Mailing Address - Phone:404-266-0111
Mailing Address - Fax:404-233-9759
Practice Address - Street 1:3580 PIEDMONT RD NE
Practice Address - Street 2:SUITE 113
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-1506
Practice Address - Country:US
Practice Address - Phone:404-266-0111
Practice Address - Fax:404-233-9759
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA 9403122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist