Individual
PHYLLIS DIANNE LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDHAP
Contact information
Practice address
5635 S VERDUN AVE, LOS ANGELES, CA 90043-2123
(310) 916-2291
Mailing address
5635 S VERDUN AVE, LOS ANGELES, CA 90043-2123
(310) 916-2291
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
HAP 142
CA
Other
Enumeration date
10/24/2011
Last updated
10/24/2011
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