=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730313883
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA A LEWIS RDH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2009
-----------------------------------------------------
Last Update Date | 05/05/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 COURT ST STE 270
-----------------------------------------------------
City | LEBANON
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03766-6313
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-448-1830
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9 ROBERTS RD
-----------------------------------------------------
City | CANAAN
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03741-7678
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-667-1003
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 124Q00000X
-----------------------------------------------------
Taxonomy Name | Dental Hygienist
-----------------------------------------------------
License Number | 2807
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------