Provider Demographics
NPI:1144237322
Name:ENSTEDT, LEWIS A (DDS)
Entity Type:Individual
Prefix:
First Name:LEWIS
Middle Name:A
Last Name:ENSTEDT
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 1:5757 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 559
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-5810
Mailing Address - Country:US
Mailing Address - Phone:323-934-9588
Mailing Address - Fax:323-934-9618
Practice Address - Street 1:5757 WILSHIRE BLVD
Practice Address - Street 2:SUITE 559
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-5810
Practice Address - Country:US
Practice Address - Phone:323-934-9588
Practice Address - Fax:323-934-9618
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0335711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice