Provider Demographics
NPI:1841463767
Name:MITCHELL-LEWIS, DENNIS ANTHONY (DDS)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:ANTHONY
Last Name:MITCHELL-LEWIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:DENNIS
Other - Middle Name:ANTHONY
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:565 MANHATTAN AVE
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-5250
Mailing Address - Country:US
Mailing Address - Phone:212-222-5221
Mailing Address - Fax:
Practice Address - Street 1:565 MANHATTAN AVE
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-5250
Practice Address - Country:US
Practice Address - Phone:212-222-5221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042899-11223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery