Provider Demographics
NPI:1073725891
Name:LEE, SEOKWOO (DDS)
Entity Type:Individual
Prefix:
First Name:SEOKWOO
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 1:13131 BROOKTREE LN
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-9499
Mailing Address - Country:US
Mailing Address - Phone:410-465-0508
Mailing Address - Fax:
Practice Address - Street 1:10750 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4251
Practice Address - Country:US
Practice Address - Phone:718-793-1777
Practice Address - Fax:718-544-5123
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053448-11223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics