MEDICARE: DR. HOLLY LEWIS DMD, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	0401411085	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1777225	OTHER	VA	UNITED CONCORDIA INS.
2	184570	OTHER	VA	ANTHEM BC/BS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073548947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HOLLY LEWIS DMD, MS

Provider Business Mailing Address
First Line	:	8203 CENTER PATH LN
Second Line	:	SUITE A
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116-4060
Country	:	US
Telephone Number	:	804-746-7382
Fax Number	:	804-746-3025

Provider Business Practice Location Address
First Line	:	11934 W BROAD ST STE 120
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23233-1100
Country	:	US
Telephone Number	:	804-746-7382
Fax Number	:	804-746-3025

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	09/23/2021

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