Provider Demographics
NPI:1457511024
Name:LEWIS, VIRGINIA JENKINS (DMD)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:JENKINS
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 1:5513 MERRIBROOK LN
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-7624
Mailing Address - Country:US
Mailing Address - Phone:859-351-1380
Mailing Address - Fax:
Practice Address - Street 1:39 BOBOLINK DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:KY
Practice Address - Zip Code:40069-1516
Practice Address - Country:US
Practice Address - Phone:859-336-7680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY86171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice