Provider Demographics
NPI:1649299413
Name:LEWIS, DONALD ANDREW (DDS)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:ANDREW
Last Name:LEWIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:D.
Other - Middle Name:ANDREW
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2101 N 34TH ST
Mailing Address - Street 2:SUITE 160
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-9149
Mailing Address - Country:US
Mailing Address - Phone:206-632-0675
Mailing Address - Fax:206-632-4117
Practice Address - Street 1:2101 N 34TH ST
Practice Address - Street 2:SUITE 160
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-9149
Practice Address - Country:US
Practice Address - Phone:206-632-0675
Practice Address - Fax:206-632-4117
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA89331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice