Provider Demographics
NPI:1699770644
Name:LEWIS, HEIDI M (DDS)
Entity type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:M
Last Name:LEWIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:HEIDI
Other - Middle Name:
Other - Last Name:LEWIS-RABINOVICH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:602 HONEYSUCKLE LN
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33327-2416
Mailing Address - Country:US
Mailing Address - Phone:954-888-6371
Mailing Address - Fax:
Practice Address - Street 1:4601 HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6501
Practice Address - Country:US
Practice Address - Phone:954-989-8800
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN160151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice