1184709867 NPI number — CEDRIC T LEWIS, DMD, LLC

Table of content: (NPI 1184709867)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184709867 NPI number — CEDRIC T LEWIS, DMD, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CEDRIC T LEWIS, DMD, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184709867
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4211 WAIALAE AVE
Provider Second Line Business Mailing Address:
SUITE 501
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96816-5306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-732-4377
Provider Business Mailing Address Fax Number:
808-732-4158

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4211 WAIALAE AVE
Provider Second Line Business Practice Location Address:
SUITE 501
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96816-5306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-732-4377
Provider Business Practice Location Address Fax Number:
808-732-4158
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LEWIS
Authorized Official First Name:
CEDRIC
Authorized Official Middle Name:
T
Authorized Official Title or Position:
SOLE MEMBER/OWNER
Authorized Official Telephone Number:
808-732-4377

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DT1943 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DT1943 . This is a "DENTAL LICENSE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 222778 . This is a "HMSA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 194302 . This is a "HDS" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 01460794 . This is a "TRICARE DENTAL PLAN" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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