Provider Demographics
NPI:1891746855
Name:LEWIS, BEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BEN
Middle Name:
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 1:13401 SUMMERLIN RD STE 8
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-6593
Mailing Address - Country:US
Mailing Address - Phone:239-415-1880
Mailing Address - Fax:239-415-1884
Practice Address - Street 1:13401 SUMMERLIN RD STE 8
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-6593
Practice Address - Country:US
Practice Address - Phone:239-415-1880
Practice Address - Fax:239-415-1884
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN6885122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist