Provider Demographics
NPI:1952405276
Name:LEWIS DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:LEWIS DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:MS
Authorized Official - First Name:OSHERRA
Authorized Official - Middle Name:D
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-637-4604
Mailing Address - Street 1:3524 N HAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75212
Mailing Address - Country:US
Mailing Address - Phone:214-637-4604
Mailing Address - Fax:214-630-9258
Practice Address - Street 1:3524 N HAMPTOM RD
Practice Address - Street 2:LEWIS DENTAL ASSOCIATES
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75212
Practice Address - Country:US
Practice Address - Phone:214-637-4604
Practice Address - Fax:214-630-9258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX9742001Medicaid
TX9742001Medicare ID - Type Unspecified