Healthcare Provider Details

I. General information

NPI: 1275799058
Provider Name (Legal Business Name): LEWIS BENJAMIN O'SHEA D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

352A BROADWAY
BETHPAGE NY
11714-3007
US

IV. Provider business mailing address

352A BROADWAY
BETHPAGE NY
11714-3007
US

V. Phone/Fax

Practice location:
  • Phone: 516-743-1388
  • Fax:
Mailing address:
  • Phone: 516-743-1388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number053969
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: