Provider Demographics
NPI:1831682640
Name:LEW, ALEXANDER JAMES (DMD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:JAMES
Last Name:LEW
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 1:5404 E CORTLAND BLVD APT 168
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-2505
Mailing Address - Country:US
Mailing Address - Phone:385-335-0014
Mailing Address - Fax:
Practice Address - Street 1:304 S REGENT ST STE 101
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-5961
Practice Address - Country:US
Practice Address - Phone:928-226-7494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD010026122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist