Provider Demographics
NPI:1861652398
Name:LEWIS, MICHAEL J (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:LEWIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:870 PALISADE AVE
Mailing Address - Street 2:SUITE #303
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3419
Mailing Address - Country:US
Mailing Address - Phone:201-836-8000
Mailing Address - Fax:201-591-7981
Practice Address - Street 1:870 PALISADE AVE
Practice Address - Street 2:SUITE #303
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3419
Practice Address - Country:US
Practice Address - Phone:201-836-8000
Practice Address - Fax:201-591-7981
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052344-11223E0200X
NJ22DI023091001223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics