Provider Demographics
NPI:1205243532
Name:LEWIS, JESSICA L (DDS)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:LEWIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3819 22ND PL
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1117
Mailing Address - Country:US
Mailing Address - Phone:806-793-5454
Mailing Address - Fax:806-793-6723
Practice Address - Street 1:3301 CLOVIS RD
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415-5155
Practice Address - Country:US
Practice Address - Phone:806-763-5557
Practice Address - Fax:806-771-7851
Is Sole Proprietor?:No
Enumeration Date:2014-07-18
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX299111223G0001X
NH04727122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist