Provider Demographics
NPI:1063582559
Name:LEWKOWSKA, AGATA (DMD)
Entity type:Individual
Prefix:DR
First Name:AGATA
Middle Name:
Last Name:LEWKOWSKA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PRESIDENTIAL BLVD
Mailing Address - Street 2:SUITE #303
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1006
Mailing Address - Country:US
Mailing Address - Phone:610-660-9510
Mailing Address - Fax:610-660-9512
Practice Address - Street 1:15 PRESIDENTIAL BLVD
Practice Address - Street 2:SUITE #303
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1006
Practice Address - Country:US
Practice Address - Phone:610-660-9510
Practice Address - Fax:610-660-9512
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0366251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice