Healthcare Provider Details

I. General information

NPI: 1891746855
Provider Name (Legal Business Name): BEN LEWIS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 04/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13401 SUMMERLIN RD STE 8
FORT MYERS FL
33919-6593
US

IV. Provider business mailing address

13401 SUMMERLIN RD STE 8
FORT MYERS FL
33919-6593
US

V. Phone/Fax

Practice location:
  • Phone: 239-415-1880
  • Fax: 239-415-1884
Mailing address:
  • Phone: 239-415-1880
  • Fax: 239-415-1884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN6885
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: