Healthcare Provider Details

I. General information

NPI: 1912747601
Provider Name (Legal Business Name): JAIME LEWIS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2024
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2A VICTORY BLVD
POQUOSON VA
23662-1947
US

IV. Provider business mailing address

235 CLAXTON CREEK RD
SEAFORD VA
23696-2052
US

V. Phone/Fax

Practice location:
  • Phone: 757-868-9334
  • Fax:
Mailing address:
  • Phone: 757-897-4353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401418910
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: