Provider Demographics
NPI:1447399035
Name:YU, LEWIS J (DMD)
Entity type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:J
Last Name:YU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4543 STONEY BATTER RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-1286
Mailing Address - Country:US
Mailing Address - Phone:302-239-1641
Mailing Address - Fax:
Practice Address - Street 1:4543 STONEY BATTER RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-1286
Practice Address - Country:US
Practice Address - Phone:302-239-1641
Practice Address - Fax:302-239-1643
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-00011801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG1-0001180OtherLICENSE