Provider Demographics
NPI:1508257908
Name:LEE, MARK C (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:C
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:333 SYLVAN AVE
Mailing Address - Street 2:STE 111
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-2724
Mailing Address - Country:US
Mailing Address - Phone:201-541-7001
Mailing Address - Fax:201-541-7007
Practice Address - Street 1:333 SYLVAN AVE
Practice Address - Street 2:STE 111
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-2724
Practice Address - Country:US
Practice Address - Phone:201-541-7001
Practice Address - Fax:201-541-7007
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-07
Last Update Date:2015-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI021693001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice