MEDICARE: PAUL I LEW DDS INC

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	1223G0001X	General Practice Dentistry	12006255A	IN

General Provider Information

NPI Number	:	1659467009
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAUL I LEW DDS INC

Provider Business Mailing Address
First Line	:	6314 NORTH RUCKER ROAD
Second Line	:	SUITE B
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-4895
Country	:	US
Telephone Number	:	317-253-8004
Fax Number	:	317-253-3861

Provider Business Practice Location Address
First Line	:	6314 NORTH RUCKER ROAD
Second Line	:	SUITE B
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-4895
Country	:	US
Telephone Number	:	317-253-8004
Fax Number	:	317-253-3861

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PAUL ILSUN LEW
Credential	:	DDS
Telephone Number	:	317-253-8004

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	08/22/2020

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