Provider Demographics
NPI:1518179340
Name:LEWIS, JONATHAN BROOKE (DMD)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:BROOKE
Last Name:LEWIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 SCHULTZ RD
Mailing Address - Street 2:
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-2952
Mailing Address - Country:US
Mailing Address - Phone:215-257-8206
Mailing Address - Fax:
Practice Address - Street 1:103 E. MAIN ST.
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:PA
Practice Address - Zip Code:18962
Practice Address - Country:US
Practice Address - Phone:215-257-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS02781821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice