Provider Demographics
NPI:1376806141
Name:WASSERMAN, LEE HARRIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:HARRIS
Last Name:WASSERMAN
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 1:3534 RHOADS AVE
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-3702
Mailing Address - Country:US
Mailing Address - Phone:610-356-9388
Mailing Address - Fax:
Practice Address - Street 1:3534 RHOADS AVE
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-3702
Practice Address - Country:US
Practice Address - Phone:610-356-9388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0394771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice