Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | HQ431632 | OH |
NPI | 1003578592 |
---|---|
Provider Name | Laura Lewis |
First Address | Cleveland, OH 44124-1929 |
Second Address | Cleveland, OH 44124-1929 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2021 |
Last Update Date | 12/10/2021 |