Provider Demographics
NPI:1225191927
Name:LEWIS, JEAN ANN (DMD)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:ANN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:677 S SALISBURY BLVD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5431
Mailing Address - Country:US
Mailing Address - Phone:410-749-0133
Mailing Address - Fax:410-749-0284
Practice Address - Street 1:677 S SALISBURY BLVD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-5431
Practice Address - Country:US
Practice Address - Phone:410-749-0133
Practice Address - Fax:410-749-0284
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2020-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ74721223P0221X, 1223P0221X
MD162601223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry