Provider Demographics
NPI:1437140563
Name:LEE, EUGENE Y (DDS)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:Y
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 1:10460 QUEENS BLVD
Mailing Address - Street 2:APT. 2C
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-7301
Mailing Address - Country:US
Mailing Address - Phone:917-446-1197
Mailing Address - Fax:
Practice Address - Street 1:10460 QUEENS BLVD
Practice Address - Street 2:SUITE 1F
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-7301
Practice Address - Country:US
Practice Address - Phone:718-459-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0506921223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02405163Medicaid