Healthcare Provider Details

I. General information

NPI: 1144233354
Provider Name (Legal Business Name): LEW DAVID WHITE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 W SAN ANTONIO ST
LOCKHART TX
78644-2421
US

IV. Provider business mailing address

1007 W SAN ANTONIO ST
LOCKHART TX
78644-2421
US

V. Phone/Fax

Practice location:
  • Phone: 512-398-3123
  • Fax: 512-376-5620
Mailing address:
  • Phone: 512-398-3123
  • Fax: 512-376-5620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12699
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: