Provider Demographics
NPI:1790952414
Name:LEWIS, ANTHONY MORITZ (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:MORITZ
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 1:21073 POWERLINE RD STE 51
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-2306
Mailing Address - Country:US
Mailing Address - Phone:561-488-4322
Mailing Address - Fax:561-487-8557
Practice Address - Street 1:21073 POWERLINE RD STE 51
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-2306
Practice Address - Country:US
Practice Address - Phone:561-488-4322
Practice Address - Fax:561-487-8557
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN9659122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist