Individual
JOSHUA LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
675 S WOODRUFF AVE, IDAHO FALLS, ID 83401-5596
(208) 538-0104
(208) 538-0106
Mailing address
675 S WOODRUFF AVE, IDAHO FALLS, ID 83401-5596
(208) 538-0104
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
2017028241
MO
122300000X
Dentist
Primary
5167
ID
1223G0001X
General Practice Dentistry
D5167
ID
Other
Enumeration date
08/07/2017
Last updated
04/30/2025
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