Provider Demographics
NPI:1912747601
Name:LEWIS, JAIME (DDS)
Entity type:Individual
Prefix:DR
First Name:JAIME
Middle Name:
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 1:235 CLAXTON CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:VA
Mailing Address - Zip Code:23696-2052
Mailing Address - Country:US
Mailing Address - Phone:757-897-4353
Mailing Address - Fax:
Practice Address - Street 1:2A VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:POQUOSON
Practice Address - State:VA
Practice Address - Zip Code:23662-1947
Practice Address - Country:US
Practice Address - Phone:757-868-9334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014189101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice