Provider Demographics
NPI:1407978836
Name:LEE, JENNIFER S (DMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:S
Last Name:LEE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W 97TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6450
Mailing Address - Country:US
Mailing Address - Phone:212-749-1820
Mailing Address - Fax:212-531-4063
Practice Address - Street 1:110 W 97TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6450
Practice Address - Country:US
Practice Address - Phone:212-749-1820
Practice Address - Fax:212-531-4063
Is Sole Proprietor?:No
Enumeration Date:2007-04-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050805122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist