Healthcare Provider Details

I. General information

NPI: 1821089798
Provider Name (Legal Business Name): THOMAS E LEWIS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8104 S 96TH ST SUITE 1
LAVISTA NE
68128-3187
US

IV. Provider business mailing address

8104 S 96TH ST SUITE 1
LAVISTA NE
68128-3187
US

V. Phone/Fax

Practice location:
  • Phone: 402-339-2141
  • Fax: 402-592-5505
Mailing address:
  • Phone: 402-339-2141
  • Fax: 402-592-5505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6132
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: