Provider Demographics
NPI:1831467554
Name:LUCINDA ANN LEWIS DDS, PC
Entity Type:Organization
Organization Name:LUCINDA ANN LEWIS DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCINDA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-367-1502
Mailing Address - Street 1:390 S POTOMAC WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-1375
Mailing Address - Country:US
Mailing Address - Phone:303-367-1502
Mailing Address - Fax:
Practice Address - Street 1:390 S POTOMAC WAY
Practice Address - Street 2:SUITE A
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-1375
Practice Address - Country:US
Practice Address - Phone:303-367-1502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO67805341Medicaid
1053319269OtherNPI