Healthcare Provider Details

I. General information

NPI: 1922526573
Provider Name (Legal Business Name): EDWARD W. LEW DMD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17024 CLARK AVE SUITE C
BELLFLOWER CA
90706
US

IV. Provider business mailing address

17024 CLARK AVE SUITE C
BELLFLOWER CA
90706-5700
US

V. Phone/Fax

Practice location:
  • Phone: 562-925-7436
  • Fax:
Mailing address:
  • Phone: 562-925-7436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number53083
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number53083
License Number StateCA

VIII. Authorized Official

Name: MR. EDWARD WESTWEALTH LEW
Title or Position: PRESIDENT
Credential: DMD
Phone: 562-925-7436