Provider Demographics
NPI:1992831101
Name:LEWIS, BERNARD ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:ALAN
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 1:149 GREAT GENEVA DR
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-5870
Mailing Address - Country:US
Mailing Address - Phone:302-943-0456
Mailing Address - Fax:
Practice Address - Street 1:149 GREAT GENEVA DR
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-5870
Practice Address - Country:US
Practice Address - Phone:302-943-0456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2013-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEGI-00011731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice