Provider Demographics
NPI:1902989742
Name:LEWIS COSMETIC & FAMILY DENTISTRY PLLC
Entity Type:Organization
Organization Name:LEWIS COSMETIC & FAMILY DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:HANLEY
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-326-1212
Mailing Address - Street 1:6711 75 STREET
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-2630
Mailing Address - Country:US
Mailing Address - Phone:718-326-1212
Mailing Address - Fax:718-894-6132
Practice Address - Street 1:6711 75 STREET
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-2630
Practice Address - Country:US
Practice Address - Phone:718-326-1212
Practice Address - Fax:718-894-6132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045565122300000X
NY024547122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty