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NPI Code Detail

MEDICARE: DR. DAVIS MICHAEL LEWIS D.D.S.

MEDICARE: DR. DAVIS MICHAEL LEWIS D.D.S.
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
1122300000XDentist3922LA

General Provider Information

NPI Number : 1225000821
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVIS MICHAEL LEWIS D.D.S.
Provider Business Mailing Address
First Line : 1840 30TH ST NE
Second Line :
City : PARIS
State : TX
Zip : 75462-2802
Country : US
Telephone Number : 903-784-5103
Fax Number :
Provider Business Practice Location Address
First Line : 902 E LINCOLN RD
Second Line :
City : IDABEL
State : OK
Zip : 74745-7337
Country : US
Telephone Number : 580-286-2600
Fax Number : 580-286-1172
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2006
Last Update Date : 06/29/2011

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