Active NPI
Scott Richard Lewis, DDS
- Dentist
- Rexburg, ID
National Provider Identifier
1790793875
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D3462
- Practice address
- 300 N 2ND E
Rexburg, ID 83440-1604 - Phone
- (208) 356-9459
- Fax
- (208) 356-5500
- NPI assigned
- Aug 4, 2006
- 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 | D3462 | ID | Primary |
Addresses
Primary practice location
300 N 2ND E
Rexburg, ID 83440-1604
Mailing address
300 N 2ND E
Rexburg, ID 83440-1604
Phone (208) 356-9459
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 |
|---|---|---|---|
| D3462 | ID | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154649600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1790793875",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 N 2ND E",
"city": "REXBURG",
"state": "ID",
"postal_code": "834401604",
"telephone_number": "208-356-9459",
"fax_number": "208-356-5500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 N 2ND E",
"city": "REXBURG",
"state": "ID",
"postal_code": "834401604",
"telephone_number": "208-356-9459",
"fax_number": "208-356-5500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEWIS",
"first_name": "SCOTT",
"middle_name": "RICHARD",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "ID",
"license": "D3462",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rexburg, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.