Provider Demographics
NPI:1053319269
Name:LEWIS, LUCINDA ANN (DDS)
Entity Type:Individual
Prefix:
First Name:LUCINDA
Middle Name:ANN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 S POTOMAC WAY
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-2491
Mailing Address - Country:US
Mailing Address - Phone:303-367-1502
Mailing Address - Fax:720-975-0001
Practice Address - Street 1:390 S POTOMAC WAY
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-2491
Practice Address - Country:US
Practice Address - Phone:303-367-1502
Practice Address - Fax:720-975-0001
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
COCO70701223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry