Provider Demographics
NPI:1942404819
Name:LEWIS, LAUREN ALEXIS (DDS)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:ALEXIS
Last Name:LEWIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W REDWOOD ST
Mailing Address - Street 2:APT. 602
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1732
Mailing Address - Country:US
Mailing Address - Phone:412-748-0823
Mailing Address - Fax:
Practice Address - Street 1:8510 PHILADELPHIA RD
Practice Address - Street 2:SUITE A
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-3015
Practice Address - Country:US
Practice Address - Phone:410-574-2800
Practice Address - Fax:410-238-0026
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14121122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist