Provider Demographics
NPI:1629703509
Name:KEVIN E. LEW, DDS, MD, PLLC
Entity Type:Organization
Organization Name:KEVIN E. LEW, DDS, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:LEW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:213-864-7670
Mailing Address - Street 1:6705 W HIGHWAY 290 STE 502-273
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-8400
Mailing Address - Country:US
Mailing Address - Phone:213-864-7670
Mailing Address - Fax:
Practice Address - Street 1:6701 RIALTO BLVD APT 2202
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-8597
Practice Address - Country:US
Practice Address - Phone:512-828-3128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3204324OtherINDIVIDUAL NUMBER
TX38024OtherDDS LICENSE
TX38024OtherDDS LICENSE