Healthcare Provider Details

I. General information

NPI: 1689778375
Provider Name (Legal Business Name): LEWIS ARTHUR HUMBERT DDS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 05/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 DENTAL SCIENCE BLDG S
IOWA CITY IA
52242-1001
US

IV. Provider business mailing address

322 DENTAL SCIENCE BLDG S
IOWA CITY IA
52242-1001
US

V. Phone/Fax

Practice location:
  • Phone: 319-385-1139
  • Fax: 319-384-1785
Mailing address:
  • Phone: 319-385-1139
  • Fax: 319-384-1785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number06250
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: