Provider Demographics
NPI:1912105719
Name:M R LEWIS DMD PC
Entity Type:Organization
Organization Name:M R LEWIS DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:585-325-2474
Mailing Address - Street 1:14 FRANKLIN ST
Mailing Address - Street 2:820 TEMPLE BLDG
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14604
Mailing Address - Country:US
Mailing Address - Phone:585-325-2474
Mailing Address - Fax:585-325-2715
Practice Address - Street 1:14 FRANKLIN ST
Practice Address - Street 2:820 TEMPLE BLDG
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14604
Practice Address - Country:US
Practice Address - Phone:585-325-2474
Practice Address - Fax:585-325-2715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030516122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty