Provider Demographics
NPI:1144635467
Name:LEWIS, JAMES BROOKE (DMD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BROOKE
Last Name:LEWIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8 ERINN CT
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:NY
Mailing Address - Zip Code:12831-2520
Mailing Address - Country:US
Mailing Address - Phone:610-420-4948
Mailing Address - Fax:
Practice Address - Street 1:713 PIERCE RD
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-1302
Practice Address - Country:US
Practice Address - Phone:518-373-1181
Practice Address - Fax:215-707-0083
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0595061223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry