Provider Demographics
NPI:1689874869
Name:LEWIS-MOODY, IRIS L (DDS)
Entity Type:Individual
Prefix:DR
First Name:IRIS
Middle Name:L
Last Name:LEWIS-MOODY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 E SCHOOL HOUSE LN
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-2235
Mailing Address - Country:US
Mailing Address - Phone:215-848-6446
Mailing Address - Fax:215-848-7202
Practice Address - Street 1:321 W GIRARD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-1531
Practice Address - Country:US
Practice Address - Phone:215-848-6446
Practice Address - Fax:215-848-7202
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024507L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist