Provider Demographics
NPI:1679603054
Name:LEWIS, ANDREW GERALD (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:GERALD
Last Name:LEWIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3509 MILL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20169-1915
Mailing Address - Country:US
Mailing Address - Phone:703-753-9473
Mailing Address - Fax:703-753-6973
Practice Address - Street 1:6735 LEA BERRY WAY
Practice Address - Street 2:
Practice Address - City:HAYMARKET
Practice Address - State:VA
Practice Address - Zip Code:20169-2991
Practice Address - Country:US
Practice Address - Phone:703-753-7077
Practice Address - Fax:703-753-6973
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010041161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice