Provider Demographics
NPI:1477798700
Name:LEE, JOSEPH
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 FARRAGUT RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-1718
Mailing Address - Country:US
Mailing Address - Phone:617-268-1030
Mailing Address - Fax:617-268-2924
Practice Address - Street 1:29 FARRAGUT ROAD SOUTH
Practice Address - Street 2:SOUTH BOSTON DENTAL
Practice Address - City:SOUTH BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127-1718
Practice Address - Country:US
Practice Address - Phone:617-268-1030
Practice Address - Fax:617-268-2924
Is Sole Proprietor?:No
Enumeration Date:2008-12-16
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19792122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist