Provider Demographics
NPI:1871668087
Name:LEWIS, NATHAN C (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:C
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 1:9730 S 700 E
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-3511
Mailing Address - Country:US
Mailing Address - Phone:801-572-3211
Mailing Address - Fax:
Practice Address - Street 1:9730 S 700 E
Practice Address - Street 2:SUITE 204
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-3511
Practice Address - Country:US
Practice Address - Phone:801-572-3211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3486269922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist