Provider Demographics
NPI:1780886507
Name:LEW, ROBERT ERNEST (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ERNEST
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 1:1515 E 25TH ST # C-153
Mailing Address - Street 2:
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-3354
Mailing Address - Country:US
Mailing Address - Phone:218-248-0342
Mailing Address - Fax:
Practice Address - Street 1:1515 E 25TH ST C-153
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-3354
Practice Address - Country:US
Practice Address - Phone:218-263-2916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA351341223G0001X
NY0402621223G0001X
MND118881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice