Provider Demographics
NPI:1285743211
Name:CHRISTINA LEWIS DDS, PC
Entity type:Organization
Organization Name:CHRISTINA LEWIS DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PC
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:800-409-2563
Mailing Address - Street 1:32885 SAND PIPER DR
Mailing Address - Street 2:
Mailing Address - City:ROMULUS
Mailing Address - State:MI
Mailing Address - Zip Code:48174-4395
Mailing Address - Country:US
Mailing Address - Phone:800-409-2563
Mailing Address - Fax:623-321-6268
Practice Address - Street 1:4502 E 41ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2553
Practice Address - Country:US
Practice Address - Phone:800-409-2563
Practice Address - Fax:623-321-6268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK58351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty