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General NPI Number Information
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NPI Number | 1003858754
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Entity Type | Organization
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Legal Business Name | BEN LEWIS, D.D.S., P.A.
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 425 N LEE ST
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City | JACKSONVILLE
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State | FL
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Zip | 32204-1127
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Country | US
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Telephone | 904-366-3736
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Fax |
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Provider Business Mailing Address
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Address Line | 11550 HIDDEN HARBOR WAY
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City | JACKSONVILLE
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State | FL
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Zip | 32223-1368
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Country | US
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Telephone | 904-268-1314
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BEN LEWIS
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Credential | D.D.S.
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Telephone | 904-268-1314
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS
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License Number State | FL
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