Provider Demographics
NPI:1417943457
Name:LEWIS, JOHN ALBAN JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALBAN
Last Name:LEWIS
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:22 MAKALAPA DR
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-3155
Mailing Address - Country:US
Mailing Address - Phone:808-423-2850
Mailing Address - Fax:
Practice Address - Street 1:480 CENTRAL AVE
Practice Address - Street 2:BUILDING 1750
Practice Address - City:PEARL HARBOR
Practice Address - State:HI
Practice Address - Zip Code:96860-4908
Practice Address - Country:US
Practice Address - Phone:808-471-5171
Practice Address - Fax:808-471-1855
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI28801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice