Healthcare Provider Details

I. General information

NPI: 1477510485
Provider Name (Legal Business Name): EMMA LOUISE LEWIS B.D.S., M.B.B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD D4-4
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

PO BOX 100405
GAINESVILLE FL
32610-0405
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-5800
  • Fax: 352-392-3070
Mailing address:
  • Phone: 352-273-5800
  • Fax: 352-392-3070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDTP 442
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: