Healthcare Provider Details

I. General information

NPI: 1144453044
Provider Name (Legal Business Name): JEFFREY D LEWIS DDS, MS, FACP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2009
Last Update Date: 08/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5099 E GRANT RD STE 330
TUCSON AZ
85712-2764
US

IV. Provider business mailing address

5099 E GRANT RD STE 330
TUCSON AZ
85712-2764
US

V. Phone/Fax

Practice location:
  • Phone: 520-325-6645
  • Fax: 520-325-5445
Mailing address:
  • Phone: 520-325-6645
  • Fax: 520-325-5445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number4158
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: