Healthcare Provider Details

I. General information

NPI: 1013198878
Provider Name (Legal Business Name): MIGUEL LEWIS DEFINA D.D.S., M.S.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2007
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 STATE RD
ASHTABULA OH
44004-6265
US

IV. Provider business mailing address

29001 CEDAR RD SUITE 450
LYNDHURST OH
44124-4062
US

V. Phone/Fax

Practice location:
  • Phone: 440-992-3146
  • Fax: 440-998-6932
Mailing address:
  • Phone: 440-461-3400
  • Fax: 440-461-1722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number30022088
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: