Provider Demographics
NPI:1497789986
Name:LEE, BRIAN B (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:B
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 1:111 WILLARD ST
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-1200
Mailing Address - Country:US
Mailing Address - Phone:617-471-2184
Mailing Address - Fax:617-471-2185
Practice Address - Street 1:111 WILLARD ST
Practice Address - Street 2:SUITE 2D
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-1200
Practice Address - Country:US
Practice Address - Phone:617-471-2184
Practice Address - Fax:617-471-2185
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA188061223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry