MEDICARE: DR. JACK WILLIAM 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	16437	TX

General Provider Information

NPI Number	:	1790780641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACK WILLIAM LEWIS DDS

Provider Business Mailing Address
First Line	:	7506 COTTONWOOD CT
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75044-2006
Country	:	US
Telephone Number	:	214-642-9460
Fax Number	:

Provider Business Practice Location Address
First Line	:	7506 COTTONWOOD CT
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75044-2006
Country	:	US
Telephone Number	:	214-642-9460
Fax Number	:

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/06/2022

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