Provider Demographics
NPI:1427091842
Name:LEWIS, AMANDA JANE (DMD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:JANE
Last Name:LEWIS
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 1:2220 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-6304
Mailing Address - Country:US
Mailing Address - Phone:217-877-1742
Mailing Address - Fax:217-877-0652
Practice Address - Street 1:2220 N MONROE ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-6304
Practice Address - Country:US
Practice Address - Phone:217-877-1742
Practice Address - Fax:217-877-0652
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist