Provider Demographics
NPI:1164642005
Name:LEE, DWIGHT BUREN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:BUREN
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 1:7221 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46214-3565
Mailing Address - Country:US
Mailing Address - Phone:317-247-0956
Mailing Address - Fax:317-247-4723
Practice Address - Street 1:7221 W 10TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46214-3565
Practice Address - Country:US
Practice Address - Phone:317-247-0956
Practice Address - Fax:317-247-4723
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009286B122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist