Provider Demographics
NPI:1518219310
Name:LEWELLING, PEGGY ANN (RDH)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:ANN
Last Name:LEWELLING
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15962 SW TUALATIN-SHERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140
Mailing Address - Country:US
Mailing Address - Phone:503-625-3767
Mailing Address - Fax:503-625-6956
Practice Address - Street 1:15962 SW TUALATIN-SHERWOOD RD
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140
Practice Address - Country:US
Practice Address - Phone:503-625-3767
Practice Address - Fax:503-625-6956
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH3868124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORH3868OtherDENTAL HYGIENE LICENSE OREGON BOARD OF DENTISTRY