Provider Demographics
NPI:1144569021
Name:LEE, CLAIRE J
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:J
Last Name:LEE
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 1:350 W 53RD ST
Mailing Address - Street 2:5G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-5751
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3160 PALM TRACE LANDINGS DR
Practice Address - Street 2:712
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-1897
Practice Address - Country:US
Practice Address - Phone:858-539-9249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-12
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057598-11223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics