Provider Demographics
NPI:1932231248
Name:BRAD LEWIS, D.M.D., P.A.
Entity Type:Organization
Organization Name:BRAD LEWIS, D.M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-944-4373
Mailing Address - Street 1:1400 NE MIAMI GARDENS DR
Mailing Address - Street 2:STE 201
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179-4845
Mailing Address - Country:US
Mailing Address - Phone:305-944-4373
Mailing Address - Fax:
Practice Address - Street 1:1400 NE MIAMI GARDENS DR
Practice Address - Street 2:STE 201
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179-4845
Practice Address - Country:US
Practice Address - Phone:305-944-4373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10097261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental