Provider Demographics
NPI:1780121350
Name:JOANNE C LEWIS PEDIATRIC DENTISTRY LLC
Entity type:Organization
Organization Name:JOANNE C LEWIS PEDIATRIC DENTISTRY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:N
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-285-2500
Mailing Address - Street 1:5700 POST RD UNIT 5
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-3455
Mailing Address - Country:US
Mailing Address - Phone:401-285-2500
Mailing Address - Fax:401-823-1702
Practice Address - Street 1:5700 POST RD UNIT 5
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-3455
Practice Address - Country:US
Practice Address - Phone:401-285-2500
Practice Address - Fax:401-823-1702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI14977293701223G0001X
RI11143625061223G0001X
RI10537592251223P0221X
14876448521223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1912036013OtherNPI
1487644852OtherNPI
1891157145OtherNPI