Provider Demographics
NPI:1467473744
Name:LEE, DEBBIE DONG EUN (DMD)
Entity Type:Individual
Prefix:DR
First Name:DEBBIE
Middle Name:DONG EUN
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 1:654 MADISON AVE RM 904
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-8436
Mailing Address - Country:US
Mailing Address - Phone:212-872-1432
Mailing Address - Fax:212-838-5061
Practice Address - Street 1:654 MADISON AVE RM 904
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-8436
Practice Address - Country:US
Practice Address - Phone:212-872-1432
Practice Address - Fax:212-838-5061
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0459451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice