Healthcare Provider Details

I. General information

NPI: 1225000821
Provider Name (Legal Business Name): DAVIS MICHAEL LEWIS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 06/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 E LINCOLN RD
IDABEL OK
74745-7337
US

IV. Provider business mailing address

1840 30TH ST NE
PARIS TX
75462-2802
US

V. Phone/Fax

Practice location:
  • Phone: 580-286-2600
  • Fax: 580-286-1172
Mailing address:
  • Phone: 903-784-5103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3922
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: