Provider Demographics
NPI:1821089798
Name:LEWIS, THOMAS E (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
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 1:8104 S 96TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LAVISTA
Mailing Address - State:NE
Mailing Address - Zip Code:68128-3187
Mailing Address - Country:US
Mailing Address - Phone:402-339-2141
Mailing Address - Fax:402-592-5505
Practice Address - Street 1:8104 S 96TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:LAVISTA
Practice Address - State:NE
Practice Address - Zip Code:68128-3187
Practice Address - Country:US
Practice Address - Phone:402-339-2141
Practice Address - Fax:402-592-5505
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6132122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE91186246-00Medicaid