Provider Demographics
NPI:1619955515
Name:LEWART, JORDAN M (DMD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:M
Last Name:LEWART
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 WESTERN HWY
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:NY
Mailing Address - Zip Code:10962-2121
Mailing Address - Country:US
Mailing Address - Phone:845-359-5588
Mailing Address - Fax:
Practice Address - Street 1:450 WESTERN HWY
Practice Address - Street 2:SUITE B
Practice Address - City:ORANGEBURG
Practice Address - State:NY
Practice Address - Zip Code:10962-2121
Practice Address - Country:US
Practice Address - Phone:845-359-5588
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042833-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice