Provider Demographics
NPI:1790007631
Name:LEWIS, TAONYA (TAONYA LEWIS)
Entity Type:Individual
Prefix:
First Name:TAONYA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:TAONYA LEWIS
Other - Prefix:
Other - First Name:TAONYA
Other - Middle Name:
Other - Last Name:PORTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15442 SCHOETTLER VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-5301
Mailing Address - Country:US
Mailing Address - Phone:636-778-0724
Mailing Address - Fax:
Practice Address - Street 1:15442 SCHOETTLER VALLEY CT
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-5301
Practice Address - Country:US
Practice Address - Phone:636-778-0724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant