Provider Demographics
NPI:1588287460
Name:LEWIS DENTAL SERVICES INC
Entity type:Organization
Organization Name:LEWIS DENTAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:225-927-6624
Mailing Address - Street 1:1119 TAMARI DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-7605
Mailing Address - Country:US
Mailing Address - Phone:225-927-6624
Mailing Address - Fax:225-927-6664
Practice Address - Street 1:1119 TAMARI DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-7605
Practice Address - Country:US
Practice Address - Phone:225-927-6624
Practice Address - Fax:225-927-6664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-26
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty