Provider Demographics
NPI:1588893945
Name:LEW, RUSSELL SOO HOO (DDS)
Entity type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:SOO HOO
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:P.O. BOX 2162
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94126-2162
Mailing Address - Country:US
Mailing Address - Phone:415-956-8888
Mailing Address - Fax:
Practice Address - Street 1:2844 SUMMIT STREET SUITE 202
Practice Address - Street 2:LOWELL B. DAVIS, DDS, MS
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3637
Practice Address - Country:US
Practice Address - Phone:510-834-3414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21605122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist