Individual provider Active NPI

Scott James Lewis, D.D.S.

  • General Practice Dentistry
  • Glendale, WI
National Provider Identifier
1609905736
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2718 Issued in WI
Practice address
5800 Bayshore Dr.
Suite B248
Glendale, WI 53217-4536
Phone
(414) 962-7110
Fax
(414) 962-7135
NPI assigned
Mar 5, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 2718 WI Primary

Addresses

Primary practice location

5800 Bayshore Dr.
Suite B248
Glendale, WI 53217-4536

Mailing address

5800 Bayshore Dr.
Suite B248
Milwaukee, WI 53217-4536
Phone (414) 962-7110

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160601001184 WI Order and Referring Only - DentistPractitioner - Dentist 7719277979

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2718WIMDHealth Psychologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1609905736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5800 BAYSHORE DR.",
            "address_2": "SUITE B248",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532174536",
            "telephone_number": "414-962-7110",
            "fax_number": "414-962-7135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5800 BAYSHORE DR.",
            "address_2": "SUITE B248",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532174536",
            "telephone_number": "414-962-7110",
            "fax_number": "414-962-7135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEWIS",
        "first_name": "SCOTT",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "2718",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, WI

Sources for this page

Verify at the official NPI Registry.