Healthcare Provider Details

I. General information

NPI: 1457636110
Provider Name (Legal Business Name): ERICA MICHELLE LEWIS RDH, BS,LAP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2011
Last Update Date: 10/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1129 NE CENTURION DR
GRESHAM OR
97030-4562
US

IV. Provider business mailing address

1129 NE CENTURION DR
GRESHAM OR
97030-4562
US

V. Phone/Fax

Practice location:
  • Phone: 541-231-2661
  • Fax:
Mailing address:
  • Phone: 541-231-2661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH6156
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: