Provider Demographics
NPI:1972910537
Name:LEWIS-MCKENZIE, ANDREA (DMD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:LEWIS-MCKENZIE
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:PO BOX 770112
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33077-0112
Mailing Address - Country:US
Mailing Address - Phone:954-951-0181
Mailing Address - Fax:
Practice Address - Street 1:7744 PETERS RD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-4004
Practice Address - Country:US
Practice Address - Phone:954-951-0181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN20754122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist