Provider Demographics
NPI:1992829261
Name:LEWIS, JEFFREY ALAN (DDS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ALAN
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 1:6060 RICHMOND AVE
Mailing Address - Street 2:SUITE 340
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-6227
Mailing Address - Country:US
Mailing Address - Phone:713-781-1733
Mailing Address - Fax:713-783-0897
Practice Address - Street 1:6060 RICHMOND AVE
Practice Address - Street 2:SUITE 340
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-6227
Practice Address - Country:US
Practice Address - Phone:713-781-1733
Practice Address - Fax:713-783-0897
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12371122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist