Provider Demographics
NPI:1730277633
Name:LEWIS, MARGERY R (DMD)
Entity type:Individual
Prefix:DR
First Name:MARGERY
Middle Name:R
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 1:1720 CROSSFIELD RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-7432
Mailing Address - Country:US
Mailing Address - Phone:366-499-7093
Mailing Address - Fax:
Practice Address - Street 1:131 MILLER ST
Practice Address - Street 2:UNIVERSITY DENTAL ASSOCIATES
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2508
Practice Address - Country:US
Practice Address - Phone:336-716-2183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS036833122300000X
NC150550390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program