Healthcare Provider Details

I. General information

NPI: 1356631360
Provider Name (Legal Business Name): REGINA L LEWIS DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 04/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11455 FALLBROOK DR SUITE 201
HOUSTON TX
77065-4238
US

IV. Provider business mailing address

11455 FALLBROOK DR SUITE 201
HOUSTON TX
77065-4238
US

V. Phone/Fax

Practice location:
  • Phone: 281-890-7475
  • Fax: 281-890-4862
Mailing address:
  • Phone: 281-890-7475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number StateTX

VIII. Authorized Official

Name: DR. REGINA L LEWIS
Title or Position: PRESIDENT
Credential: DDS
Phone: 281-890-7475