Provider Demographics
NPI:1679705537
Name:LEWIS, JANE WELLESLEY (DMD)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:WELLESLEY
Last Name:LEWIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:JANE
Other - Middle Name:WELLESLEY
Other - Last Name:GLEIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1615 RIDGE HAVEN RUN
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-4485
Mailing Address - Country:US
Mailing Address - Phone:678-644-0493
Mailing Address - Fax:
Practice Address - Street 1:407 E MAPLE ST STE 109
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2616
Practice Address - Country:US
Practice Address - Phone:770-343-4389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-11
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0139521223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry