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General NPI Number Information
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NPI Number | 1952577587
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Entity Type | Individual
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Provider Name | CHARLES H LEWIS D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/04/2008
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Last Update Date | 05/04/2008
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Provider Practice Location Address
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Address Line | 2490 WALTON BLVD SUITE 202
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City | ROCHESTER HILLS
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State | MI
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Zip | 48309-1484
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Country | US
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Telephone | 248-656-2244
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Fax |
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Provider Business Mailing Address
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Address Line | 900 ASPEN DR
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City | ROCHESTER
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State | MI
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Zip | 48307-1005
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Country | US
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Telephone | 248-651-2422
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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 | 2901008084
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License Number State | MI
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