Provider Demographics
NPI:1124511787
Name:LEWIS, HENRY ARTHUR (DMD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:ARTHUR
Last Name:LEWIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 520
Mailing Address - Street 2:
Mailing Address - City:MOAPA
Mailing Address - State:NV
Mailing Address - Zip Code:89025-0520
Mailing Address - Country:US
Mailing Address - Phone:702-649-6859
Mailing Address - Fax:
Practice Address - Street 1:4890 E BONANZA RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-3458
Practice Address - Country:US
Practice Address - Phone:702-649-6859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-08
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV71731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice