Provider Demographics
NPI:1255394706
Name:LEWIS, JOAN MARY (DDS,MSD)
Entity type:Individual
Prefix:DR
First Name:JOAN
Middle Name:MARY
Last Name:LEWIS
Suffix:
Gender:F
Credentials:DDS,MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 WALDON PARK DR
Mailing Address - Street 2:
Mailing Address - City:ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48359-1334
Mailing Address - Country:US
Mailing Address - Phone:248-391-2122
Mailing Address - Fax:248-625-5475
Practice Address - Street 1:5649 SASHABAW RD
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-3149
Practice Address - Country:US
Practice Address - Phone:248-625-1721
Practice Address - Fax:248-625-5475
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010145301223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics