Provider Demographics
NPI:1366422503
Name:LEWIS, MICHAEL TODD (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:TODD
Last Name:LEWIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 E BELVEDERE RD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-4804
Mailing Address - Country:US
Mailing Address - Phone:757-489-4969
Mailing Address - Fax:757-489-7154
Practice Address - Street 1:DENTAL DEPARTMENT USS NASSAU (LHA-4)
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09557-1615
Practice Address - Country:US
Practice Address - Phone:757-444-1410
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010062841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice