Provider Demographics
NPI:1831241744
Name:RAYMOND C. LYEW D.D.S., P.C.
Entity type:Organization
Organization Name:RAYMOND C. LYEW D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST - CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:C
Authorized Official - Last Name:LYEW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:678-344-5511
Mailing Address - Street 1:3060 RIVER DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-5526
Mailing Address - Country:US
Mailing Address - Phone:678-344-5511
Mailing Address - Fax:678-344-5577
Practice Address - Street 1:3060 RIVER DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-5526
Practice Address - Country:US
Practice Address - Phone:678-344-5511
Practice Address - Fax:678-344-5577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA109551223P0221X
GA102871223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty