Healthcare Provider Details

I. General information

NPI: 1184709867
Provider Name (Legal Business Name): CEDRIC T LEWIS, DMD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 WAIALAE AVE SUITE 501
HONOLULU HI
96816-5306
US

IV. Provider business mailing address

4211 WAIALAE AVE SUITE 501
HONOLULU HI
96816-5306
US

V. Phone/Fax

Practice location:
  • Phone: 808-732-4377
  • Fax: 808-732-4158
Mailing address:
  • Phone: 808-732-4377
  • Fax: 808-732-4158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDT1943
License Number StateHI

VIII. Authorized Official

Name: DR. CEDRIC T LEWIS
Title or Position: SOLE MEMBER/OWNER
Credential: DMD
Phone: 808-732-4377