Provider Demographics
NPI:1043371461
Name:LEE, BANGHUN (DDS)
Entity Type:Individual
Prefix:
First Name:BANGHUN
Middle Name:
Last Name:LEE
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 1:11 E HARWOOD TER
Mailing Address - Street 2:
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650-3184
Mailing Address - Country:US
Mailing Address - Phone:917-669-0693
Mailing Address - Fax:201-944-0212
Practice Address - Street 1:11 E HARWOOD TER
Practice Address - Street 2:
Practice Address - City:PALISADES PARK
Practice Address - State:NJ
Practice Address - Zip Code:07650-3184
Practice Address - Country:US
Practice Address - Phone:201-944-0550
Practice Address - Fax:201-944-0212
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054204122300000X
NJ22DI02258600122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist