Healthcare Provider Details

I. General information

NPI: 1588287460
Provider Name (Legal Business Name): LEWIS DENTAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2020
Last Update Date: 05/26/2020
Certification Date: 05/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 TAMARI DR
BATON ROUGE LA
70815-7605
US

IV. Provider business mailing address

1119 TAMARI DR
BATON ROUGE LA
70815-7605
US

V. Phone/Fax

Practice location:
  • Phone: 225-927-6624
  • Fax: 225-927-6664
Mailing address:
  • Phone: 225-927-6624
  • Fax: 225-927-6664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: LEONARD LEWIS III
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 225-927-6624