Provider Demographics
NPI:1326377649
Name:LEE, ELLIOT YOUNG (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:YOUNG
Last Name:LEE
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 1:865 EASTON RD
Mailing Address - Street 2:SUITE #110
Mailing Address - City:WARRINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:18976-1838
Mailing Address - Country:US
Mailing Address - Phone:267-483-8351
Mailing Address - Fax:267-483-8359
Practice Address - Street 1:865 EASTON RD
Practice Address - Street 2:SUITE #110
Practice Address - City:WARRINGTON
Practice Address - State:PA
Practice Address - Zip Code:18976-1838
Practice Address - Country:US
Practice Address - Phone:267-483-8351
Practice Address - Fax:267-483-8359
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-15
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS038105122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist