MEDICARE: KELLY LEWIS DDS

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	1223G0001X	General Practice Dentistry	0401412516	VA
2	1223P0221X	Pediatric Dentistry	DS039890	PA

General Provider Information

NPI Number	:	1124347950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY LEWIS DDS

Provider Business Mailing Address
First Line	:	1325 MILTON ST
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15218-1234
Country	:	US
Telephone Number	:	703-819-5276
Fax Number	:

Provider Business Practice Location Address
First Line	:	1325 MILTON ST
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15218-1234
Country	:	US
Telephone Number	:	703-819-5276
Fax Number	:

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

Provider Enumeration Date	:	05/18/2010
Last Update Date	:	05/04/2016

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Directions to “ KELLY LEWIS DDS” Practice Location

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