Provider Demographics
NPI:1760592059
Name:LEW, VERNON MILES (DDS)
Entity Type:Individual
Prefix:
First Name:VERNON
Middle Name:MILES
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 1:1848 SARATOGA AVE
Mailing Address - Street 2:BUILDING 3
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070
Mailing Address - Country:US
Mailing Address - Phone:408-364-2447
Mailing Address - Fax:408-364-1238
Practice Address - Street 1:1848 SARATOGA AVE
Practice Address - Street 2:BUILDING 3
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070
Practice Address - Country:US
Practice Address - Phone:408-364-2447
Practice Address - Fax:408-364-1238
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35633122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist