Provider Demographics
NPI:1366005969
Name:LEE, JANET JEONGHWA (BSC , DDS)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:JEONGHWA
Last Name:LEE
Suffix:
Gender:F
Credentials:BSC , DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3075 RIDGEWAY DRIVE
Mailing Address - Street 2:UNIT 18
Mailing Address - City:MISSISSAUGA
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:L5L 5M6
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:260 E 188TH STREET , ST. BARNABAS HOSPITAL
Practice Address - Street 2:1ST FLOOR , DIVISION OF ORTHODONTICS
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458
Practice Address - Country:US
Practice Address - Phone:718-618-8935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060305122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist