Provider Demographics
NPI:1578767471
Name:LEW, MICHAEL F (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:F
Last Name:LEW
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3600 LOMITA BLVD
Mailing Address - Street 2:STE.201
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3900
Mailing Address - Country:US
Mailing Address - Phone:310-539-7650
Mailing Address - Fax:310-539-8292
Practice Address - Street 1:3600 LOMITA BLVD
Practice Address - Street 2:STE.201
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3900
Practice Address - Country:US
Practice Address - Phone:310-539-7650
Practice Address - Fax:310-539-8292
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA471181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice