Healthcare Provider Details

I. General information

NPI: 1568566982
Provider Name (Legal Business Name): REGINA L LEWIS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11301 FALLBROOK DR STE 329
HOUSTON TX
77065-0014
US

IV. Provider business mailing address

11301 FALLBROOK DR STE 329
HOUSTON TX
77065-0014
US

V. Phone/Fax

Practice location:
  • Phone: 281-890-7475
  • Fax: 281-890-4862
Mailing address:
  • Phone: 713-724-6717
  • Fax: 281-890-4862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number13196
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: