Healthcare Provider Details

I. General information

NPI: 1477246569
Provider Name (Legal Business Name): THOMAS LEWIS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2023
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 N BROADWAY ST
SPRING VALLEY MN
55975-1029
US

IV. Provider business mailing address

823 N BROADWAY ST
SPRING VALLEY MN
55975-1029
US

V. Phone/Fax

Practice location:
  • Phone: 507-346-7281
  • Fax:
Mailing address:
  • Phone: 507-346-7281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD14896
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: