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General NPI Number Information
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NPI Number | 1043385107
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Entity Type | Organization
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Legal Business Name | J DENNIS LEWIS DDS PC
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 07/03/2008
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Provider Practice Location Address
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Address Line | 1770 E LAMBERT RD #220
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City | BREA
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State | CA
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Zip | 92821-4372
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Country | US
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Telephone | 714-990-8891
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Fax | 714-990-1649
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Provider Business Mailing Address
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Address Line | 410 WEST CENTRAL AVE #201
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City | BREA
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State | CA
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Zip | 92821
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Country | US
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Telephone | 714-990-8891
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Fax | 714-990-1649
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MRS. CAROLYN C LEWIS
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Credential | CDA
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Telephone | 714-990-8891
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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 | 27162
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 27162
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License Number State | CA
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