Provider Demographics
NPI:1811151152
Name:LEWISVILLE DENTAL ASSOCIATES, PLLC
Entity type:Organization
Organization Name:LEWISVILLE DENTAL ASSOCIATES, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REX
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-221-9136
Mailing Address - Street 1:105 KATHRYN DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-4216
Mailing Address - Country:US
Mailing Address - Phone:972-221-9136
Mailing Address - Fax:972-353-3722
Practice Address - Street 1:105 KATHRYN DR
Practice Address - Street 2:SUITE A
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-4216
Practice Address - Country:US
Practice Address - Phone:972-221-9136
Practice Address - Fax:972-353-3722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13793261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental