Provider Demographics
NPI:1891355848
Name:LEWIS, DAVID A (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:LEWIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 FOULK RD STE 204
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-3802
Mailing Address - Country:US
Mailing Address - Phone:302-762-6400
Mailing Address - Fax:
Practice Address - Street 1:410 FOULK RD STE 204
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3802
Practice Address - Country:US
Practice Address - Phone:302-762-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0425481223G0001X
DEG1-00114871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice