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General NPI Number Information
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NPI Number | 1043576150
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Entity Type | Organization
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Legal Business Name | JASON D LEWIS DDS PA
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Dates
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Enumeration Date | 04/03/2012
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Last Update Date | 05/30/2012
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Provider Practice Location Address
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Address Line | 130 GATEWAY CIR
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City | JACKSONVILLE
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State | FL
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Zip | 32259-4003
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Country | US
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Telephone | 904-201-6000
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Fax | 904-201-6004
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Provider Business Mailing Address
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Address Line | 130 GATEWAY CIR
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City | JACKSONVILLE
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State | FL
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Zip | 32259-4003
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Country | US
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Telephone | 904-201-6000
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Fax | 904-201-6004
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. JASON DEAN LEWIS
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Credential | DDS
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Telephone | 904-201-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | DN16561
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License Number State | FL
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