MEDICARE: DR. WILLIAM LEWCZUK DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	38869	CA

General Provider Information

NPI Number	:	1396875027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM LEWCZUK DDS

Provider Business Mailing Address
First Line	:	5906 MONTEREY RD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90042-4943
Country	:	US
Telephone Number	:	323-256-2680
Fax Number	:	323-341-5668

Provider Business Practice Location Address
First Line	:	5906 MONTEREY RD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90042-4943
Country	:	US
Telephone Number	:	323-256-2680
Fax Number	:	323-341-5668

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	07/08/2007

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