Provider Demographics
NPI:1104816560
Name:LEWIS, BEVERLY H (DDS)
Entity type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:H
Last Name:LEWIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38107-1703
Mailing Address - Country:US
Mailing Address - Phone:901-525-3800
Mailing Address - Fax:901-525-4040
Practice Address - Street 1:1216 THOMAS ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38107-1703
Practice Address - Country:US
Practice Address - Phone:901-525-3800
Practice Address - Fax:901-525-4040
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN76101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice