Provider Demographics
NPI:1649506098
Name:FACTOR, LEWIS HARVEY (DMD)
Entity type:Individual
Prefix:
First Name:LEWIS
Middle Name:HARVEY
Last Name:FACTOR
Suffix:
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 1:9000 S.W. 152 ST.
Mailing Address - Street 2:SUITE 209
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1942
Mailing Address - Country:US
Mailing Address - Phone:305-253-1030
Mailing Address - Fax:305-254-3900
Practice Address - Street 1:9000 S.W. 152 ST.
Practice Address - Street 2:SUITE 209
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-1942
Practice Address - Country:US
Practice Address - Phone:305-253-1030
Practice Address - Fax:305-254-3900
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN054791223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics