Provider Demographics
NPI:1447350277
Name:LEWIS, BRENDA LAMB
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:LAMB
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 N SAN MATEO DR
Mailing Address - Street 2:100
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2621
Mailing Address - Country:US
Mailing Address - Phone:650-348-4030
Mailing Address - Fax:650-348-7213
Practice Address - Street 1:235 N SAN MATEO DR
Practice Address - Street 2:100
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2621
Practice Address - Country:US
Practice Address - Phone:650-348-4030
Practice Address - Fax:650-348-7213
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA500731223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics