Provider Demographics
NPI:1619189248
Name:LEW, BRENT SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:SCOTT
Last Name:LEW
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 1:12062 VALLEY VIEW ST
Mailing Address - Street 2:STE 250
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845-1770
Mailing Address - Country:US
Mailing Address - Phone:714-893-8571
Mailing Address - Fax:714-897-4799
Practice Address - Street 1:12062 VALLEY VIEW ST
Practice Address - Street 2:SUITE 250
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92845-1737
Practice Address - Country:US
Practice Address - Phone:714-893-8571
Practice Address - Fax:714-897-4799
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0354201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice