Provider Demographics
NPI:1962544437
Name:LEWIS, PAUL LEE (DDS)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:LEE
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 1:2802 NORTH SAGINAW ROAD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-2634
Mailing Address - Country:US
Mailing Address - Phone:989-631-2562
Mailing Address - Fax:989-631-1004
Practice Address - Street 1:2802 NORTH SAGINAW ROAD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-2634
Practice Address - Country:US
Practice Address - Phone:989-631-2562
Practice Address - Fax:989-631-1004
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901012525122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist