Provider Demographics
NPI:1407823388
Name:LEE, SUNG (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUNG
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:CLOSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07624-1805
Mailing Address - Country:US
Mailing Address - Phone:201-567-3368
Mailing Address - Fax:201-567-0060
Practice Address - Street 1:15 BROADWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:CRESSKILL
Practice Address - State:NJ
Practice Address - Zip Code:07626-2107
Practice Address - Country:US
Practice Address - Phone:201-567-3368
Practice Address - Fax:201-567-0060
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI022985001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice