Healthcare Provider Details

I. General information

NPI: 1689506818
Provider Name (Legal Business Name): MADISON RAYANNA LEWIS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 TOWN AND COUNTRY LANE SUITE 102
HAZARD KY
41701
US

IV. Provider business mailing address

48 CHESTNUT LOG BR
HAZARD KY
41701
US

V. Phone/Fax

Practice location:
  • Phone: 606-435-7676
  • Fax: 606-436-5139
Mailing address:
  • Phone: 606-369-4156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD-00227
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: