Provider Demographics
NPI:1487210001
Name:LEE, BRYAN R
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:R
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 1:176 E HARBOR
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-3553
Mailing Address - Country:US
Mailing Address - Phone:615-430-4405
Mailing Address - Fax:
Practice Address - Street 1:1005 DR. D.B. TODD JR. BOULEVARD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37208-3599
Practice Address - Country:US
Practice Address - Phone:615-720-6427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10956122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist