Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | CO7070 | CO |
NPI | 1053319269 |
---|---|
Provider Name | Lucinda Ann Lewis |
First Address | Aurora, CO 80012-2491 |
Second Address | Aurora, CO 80012-2491 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2005 |
Last Update Date | 08/07/2007 |