Provider Demographics
NPI:1639433790
Name:LEWIS, AMY LAUREN (DDS)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LAUREN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LAUREN
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:801 S PAULINA ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-7210
Mailing Address - Country:US
Mailing Address - Phone:312-996-7532
Mailing Address - Fax:
Practice Address - Street 1:5023 MARKET ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3429
Practice Address - Country:US
Practice Address - Phone:910-442-3443
Practice Address - Fax:910-795-1877
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0392231223G0001X
NC112361223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice