Active NPI
Jeremy Allen Lewis, DMD
- Dentist
- Marianna, FL
National Provider Identifier
1427033661
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN17076
- Practice address
- 4307 3Rd Ave
Marianna, FL 32446-2177 - Phone
- (850) 526-4220
- NPI assigned
- Dec 9, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN17076 | FL | Primary |
Addresses
Primary practice location
4307 3Rd Ave
Marianna, FL 32446-2177
Mailing address
4307 3Rd Ave
Marianna, FL 32446-2177
Phone (850) 526-4220
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 076091900 | Medicaid | FL | |
| DC17076 | Other | FL | DENTAL LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN17076 | FL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1134086400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1490659200000",
"number": "1427033661",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4307 3RD AVE",
"city": "MARIANNA",
"state": "FL",
"postal_code": "324462177",
"telephone_number": "850-526-4220"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4307 3RD AVE",
"city": "MARIANNA",
"state": "FL",
"postal_code": "324462177",
"telephone_number": "850-526-4220"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEWIS",
"first_name": "JEREMY",
"middle_name": "ALLEN",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-12-09",
"last_updated": "2017-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "DN17076",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "076091900",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTAL LICENSE",
"identifier": "DC17076",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Marianna, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.