Healthcare Provider Details

I. General information

NPI: 1174502736
Provider Name (Legal Business Name): RODNEY PAUL LEWIS D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 BUCKINGHAM RD SUITE 200
RICHARDSON TX
75081-5850
US

IV. Provider business mailing address

1001 BUCKINGHAM RD SUITE 200
RICHARDSON TX
75081-5850
US

V. Phone/Fax

Practice location:
  • Phone: 972-907-9900
  • Fax: 972-907-9925
Mailing address:
  • Phone: 972-907-9900
  • Fax: 972-907-9925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number19681
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: