Active NPI
Timothy Dallas Lewis, D.D.S.
- General Practice Dentistry
- Yucaipa, CA
National Provider Identifier
1679769012
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 56330
- Practice address
- 10938 Plum View LN
Yucaipa, CA 92399-9310 - Phone
- (909) 844-2327
- NPI assigned
- Sep 19, 2007
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 56330 | CA | Primary |
Addresses
Primary practice location
10938 Plum View LN
Yucaipa, CA 92399-9310
Mailing address
10938 Plum View LN
Yucaipa, CA 92399-9310
Phone (909) 844-2327
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 |
|---|---|---|---|
| 56330 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190160000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1303776000000",
"number": "1679769012",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10938 PLUM VIEW LN",
"city": "YUCAIPA",
"state": "CA",
"postal_code": "923999310",
"telephone_number": "909-844-2327"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10938 PLUM VIEW LN",
"city": "YUCAIPA",
"state": "CA",
"postal_code": "923999310",
"telephone_number": "909-844-2327"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEWIS",
"first_name": "TIMOTHY",
"middle_name": "DALLAS",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-09-19",
"last_updated": "2011-04-26",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "56330",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Yucaipa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.