Provider Demographics
NPI:1144453044
Name:LEWIS, JEFFREY D (DDS, MS, FACP)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:D
Last Name:LEWIS
Suffix:
Gender:M
Credentials:DDS, MS, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5099 E GRANT RD STE 330
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2764
Mailing Address - Country:US
Mailing Address - Phone:520-325-6645
Mailing Address - Fax:520-325-5445
Practice Address - Street 1:5099 E GRANT RD STE 330
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2764
Practice Address - Country:US
Practice Address - Phone:520-325-6645
Practice Address - Fax:520-325-5445
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ41581223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics