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General NPI Number Information
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NPI Number | 1073664074
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Entity Type | Organization
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Legal Business Name | NORTHEAST ORAL & MAXILLOFACIAL SURGEONS, INC
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 26300 EUCLID AVE SUITE 410
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City | EUCLID
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State | OH
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Zip | 44132-3708
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Country | US
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Telephone | 216-261-1010
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Fax | 216-261-9442
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Provider Business Mailing Address
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Address Line | 26300 EUCLID AVE SUITE 410
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City | EUCLID
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State | OH
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Zip | 44132-3708
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Country | US
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Telephone | 216-261-1010
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Fax | 216-261-9442
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DONALD P LEWIS JR.
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Credential | DDS
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Telephone | 216-261-1010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 30-015177
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License Number State | OH
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