Provider Demographics
NPI:1225010036
Name:MCNEISH, LEE W (DMD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:W
Last Name:MCNEISH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 CHASE PKWY
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3040
Mailing Address - Country:US
Mailing Address - Phone:203-596-7788
Mailing Address - Fax:203-596-7194
Practice Address - Street 1:650 CHASE PKWY
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3040
Practice Address - Country:US
Practice Address - Phone:203-596-7788
Practice Address - Fax:203-596-7194
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT72271223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTU17290Medicare UPIN
CT190000724Medicare PIN