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General NPI Number Information
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NPI Number | 1689358897
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Entity Type | Individual
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Provider Name | MIA LEWIS
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Gender | Female
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Dates
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Enumeration Date | 06/09/2023
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Last Update Date | 08/14/2024
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Provider Practice Location Address
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Address Line | 7001 LAPALCO BLVD
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City | MARRERO
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State | LA
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Zip | 70072-4503
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Country | US
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Telephone | 504-341-4006
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5414
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City | WEST MEMPHIS
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State | AR
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Zip | 72303-5414
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Country | US
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Telephone | 870-636-1344
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 7612
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License Number State | LA
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