Provider Demographics
NPI:1952904922
Name:MARK LEWANDOWSKI DDS PC
Entity Type:Organization
Organization Name:MARK LEWANDOWSKI DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:AVRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-345-1391
Mailing Address - Street 1:420 E HOUGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-1130
Mailing Address - Country:US
Mailing Address - Phone:989-345-1391
Mailing Address - Fax:989-345-1601
Practice Address - Street 1:420 E HOUGHTON AVE
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-1130
Practice Address - Country:US
Practice Address - Phone:989-345-1391
Practice Address - Fax:989-345-1601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty