Provider Demographics
NPI:1356566921
Name:HEWITT, LORI (DDS)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:HEWITT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14623 HAWTHORNE BLVD
Mailing Address - Street 2:107
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-1581
Mailing Address - Country:US
Mailing Address - Phone:310-579-3171
Mailing Address - Fax:310-679-2306
Practice Address - Street 1:14623 HAWTHORNE BLVD
Practice Address - Street 2:107
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-1581
Practice Address - Country:US
Practice Address - Phone:310-579-3171
Practice Address - Fax:310-679-2306
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA450201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice