MEDICARE: GEORGEANA LEWIS DMD

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	DN15436	FL

General Provider Information

NPI Number	:	1669665956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGEANA LEWIS DMD

Provider Business Mailing Address
First Line	:	1660 NE MIAMI GARDENS DR
Second Line	:	SUITE 3
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33179-4924
Country	:	US
Telephone Number	:	305-940-3135
Fax Number	:	305-944-6602

Provider Business Practice Location Address
First Line	:	1660 NE MIAMI GARDENS DR
Second Line	:	SUITE 3
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33179-4924
Country	:	US
Telephone Number	:	305-940-3135
Fax Number	:	305-944-6602

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

Provider Enumeration Date	:	08/21/2007
Last Update Date	:	03/23/2012

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