Healthcare Provider Details

I. General information

NPI: 1821001983
Provider Name (Legal Business Name): JOHN G LEWIS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 SEARSPORT AVE
BELFAST ME
04915-7220
US

IV. Provider business mailing address

94 SEARSPORT AVE
BELFAST ME
04915-7220
US

V. Phone/Fax

Practice location:
  • Phone: 207-338-1100
  • Fax: 207-338-3098
Mailing address:
  • Phone: 207-338-1100
  • Fax: 207-338-3098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3445
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: