Provider Demographics
NPI:1366554545
Name:LEW, DOUGLAS S (DDS)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:S
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 1:1691 EL CAMINO REAL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306
Mailing Address - Country:US
Mailing Address - Phone:650-324-1292
Mailing Address - Fax:650-618-1944
Practice Address - Street 1:1691 EL CAMINO REAL
Practice Address - Street 2:SUITE 200
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306
Practice Address - Country:US
Practice Address - Phone:650-324-1292
Practice Address - Fax:650-618-1944
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38317122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist