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General NPI Number Information
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NPI Number | 1558495341
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Entity Type | Individual
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Provider Name | MONICA LEWIS D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 16800 W 12 MILE RD SUITE 103
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City | SOUTHFIELD
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State | MI
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Zip | 48076-2108
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Country | US
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Telephone | 248-443-5371
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Fax |
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Provider Business Mailing Address
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Address Line | 27268 PEMBRIDGE LN
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City | FARMINGTON HILLS
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State | MI
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Zip | 48331-3671
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Country | US
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Telephone | 248-478-7838
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 15215
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License Number State | MI
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