Provider Demographics
NPI:1174652986
Name:LEE, JOHN H (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:H
Last Name:LEE
Suffix:
Gender:M
Credentials:DMD
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Mailing Address - Street 1:80 MAPLE AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3520
Mailing Address - Country:US
Mailing Address - Phone:631-724-7575
Mailing Address - Fax:631-724-4790
Practice Address - Street 1:80 MAPLE AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3520
Practice Address - Country:US
Practice Address - Phone:631-724-7575
Practice Address - Fax:631-724-4790
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY0503811223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics