# VICTORY POINT DENTAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578722765
- **Authorized official:** DR. DAVID M LEWIS DDS (OWNER/DENTIST)
- **Authorized official phone:** (208) 888-5470

## Contact information

- **Practice address:** 3175 S MERIDIAN RD, SUITE 150, MERIDIAN, ID 83642-7088
- **Practice address phone:** (208) 888-5470
- **Practice address fax:** (208) 288-0279
- **Mailing address:** 3175 S MERIDIAN RD, SUITE 150, MERIDIAN, ID 83642-7088
- **Mailing address phone:** (208) 888-5470
- **Mailing address fax:** (208) 288-0279

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D-3810 | ID | Yes |

## Other

- **Enumeration date:** 06/03/2008
- **Last updated:** 06/03/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 01622474 | UNITED CONCORDIA | ID |
| 05 | — | 806916200 | — | ID |