Provider Demographics
NPI:1477161768
Name:LEE, YO SEP (DMD)
Entity Type:Individual
Prefix:
First Name:YO SEP
Middle Name:
Last Name:LEE
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 1:6831 N NEIL PL
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-2824
Mailing Address - Country:US
Mailing Address - Phone:414-732-6038
Mailing Address - Fax:
Practice Address - Street 1:710 W HISTORIC MITCHELL ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-3556
Practice Address - Country:US
Practice Address - Phone:414-383-2426
Practice Address - Fax:877-335-3684
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-22
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10023571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice