Provider Demographics
NPI:1568726347
Name:LEWICKI, ALBERT FRANCIS II (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:FRANCIS
Last Name:LEWICKI
Suffix:II
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 1:499 NW PRIMA VISTA BLVD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-8786
Mailing Address - Country:US
Mailing Address - Phone:772-336-1500
Mailing Address - Fax:
Practice Address - Street 1:499 NW PRIMA VISTA BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-8786
Practice Address - Country:US
Practice Address - Phone:772-336-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18559561223G0001X
FLDN215411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice