Provider Demographics
NPI:1134485303
Name:LEW, LESLIE ALLAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:ALLAN
Last Name:LEW
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DAVID LN
Mailing Address - Street 2:SUITE5G
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1116
Mailing Address - Country:US
Mailing Address - Phone:914-375-0660
Mailing Address - Fax:914-423-8414
Practice Address - Street 1:1 DAVID LN
Practice Address - Street 2:SUITE5G
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1116
Practice Address - Country:US
Practice Address - Phone:914-375-0660
Practice Address - Fax:914-423-8414
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028283122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist