Provider Demographics
NPI:1134893043
Name:LEWIS, LAUREN METZEL (DDS)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:METZEL
Last Name:LEWIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:METZEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:901 S MOPAC EXPY STE 470
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5776
Mailing Address - Country:US
Mailing Address - Phone:512-327-6947
Mailing Address - Fax:
Practice Address - Street 1:901 S MOPAC EXPY STE 470
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5776
Practice Address - Country:US
Practice Address - Phone:512-327-6947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXETN851122300000X
TX376251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist