Provider Demographics
NPI:1891893673
Name:LEWIS, DONALD P JR (DDS)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:P
Last Name:LEWIS
Suffix:JR
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 1:26300 EUCLID AVENUE
Mailing Address - Street 2:SUITE 410
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132
Mailing Address - Country:US
Mailing Address - Phone:216-261-1010
Mailing Address - Fax:216-261-9442
Practice Address - Street 1:26300 EUCLID AVENUE
Practice Address - Street 2:SUITE 410
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132
Practice Address - Country:US
Practice Address - Phone:216-261-1010
Practice Address - Fax:216-261-9442
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30015177204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T47184Medicare UPIN
OH0563252Medicare ID - Type Unspecified