Provider Demographics
NPI:1720380447
Name:JOANNE C. LEWIS PEDIATRIC DENTISTRY, LLC
Entity Type:Organization
Organization Name:JOANNE C. LEWIS PEDIATRIC DENTISTRY, LLC
Other - Org Name:CHILDREN'S DENTISTRY OF COVENTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:401-823-1700
Mailing Address - Street 1:840 TIOGUE AVE
Mailing Address - Street 2:FRONT OFFICE
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816-5914
Mailing Address - Country:US
Mailing Address - Phone:401-823-1700
Mailing Address - Fax:401-823-1702
Practice Address - Street 1:840 TIOGUE AVE
Practice Address - Street 2:FRONT OFFICE
Practice Address - City:COVENTRY
Practice Address - State:RI
Practice Address - Zip Code:02816-5914
Practice Address - Country:US
Practice Address - Phone:401-823-1700
Practice Address - Fax:401-823-1702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty