Provider Demographics
NPI:1821001983
Name:LEWIS, JOHN G (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:G
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 1:94 SEARSPORT AVE
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-7220
Mailing Address - Country:US
Mailing Address - Phone:207-338-1100
Mailing Address - Fax:207-338-3098
Practice Address - Street 1:94 SEARSPORT AVE
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-7220
Practice Address - Country:US
Practice Address - Phone:207-338-1100
Practice Address - Fax:207-338-3098
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME34451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice