Provider Demographics
NPI:1184709867
Name:CEDRIC T LEWIS, DMD, LLC
Entity type:Organization
Organization Name:CEDRIC T LEWIS, DMD, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CEDRIC
Authorized Official - Middle Name:T
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:808-732-4377
Mailing Address - Street 1:4211 WAIALAE AVE
Mailing Address - Street 2:SUITE 501
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-5306
Mailing Address - Country:US
Mailing Address - Phone:808-732-4377
Mailing Address - Fax:808-732-4158
Practice Address - Street 1:4211 WAIALAE AVE
Practice Address - Street 2:SUITE 501
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-5306
Practice Address - Country:US
Practice Address - Phone:808-732-4377
Practice Address - Fax:808-732-4158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT19431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIDT1943OtherDENTAL LICENSE
HI222778OtherHMSA
HI194302OtherHDS
HI01460794OtherTRICARE DENTAL PLAN