Provider Demographics
NPI:1629034756
Name:EGELAND-LEWIS, MARTHA (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:
Last Name:EGELAND-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 1:825 BATTLEFIELD BLVD S
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-6607
Mailing Address - Country:US
Mailing Address - Phone:757-482-2876
Mailing Address - Fax:757-546-0235
Practice Address - Street 1:825 BATTLEFIELD BLVD S
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-6607
Practice Address - Country:US
Practice Address - Phone:757-482-2876
Practice Address - Fax:757-546-0235
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401411399122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist