Provider Demographics
NPI:1841818978
Name:LEWIS, BRIGHAM ERIC (DMD)
Entity type:Individual
Prefix:DR
First Name:BRIGHAM
Middle Name:ERIC
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:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18962-0490
Mailing Address - Country:US
Mailing Address - Phone:215-257-1100
Mailing Address - Fax:
Practice Address - Street 1:103 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:PA
Practice Address - Zip Code:18962-1896
Practice Address - Country:US
Practice Address - Phone:215-257-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS042738122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist