Provider Demographics
NPI:1518186048
Name:LEE, CAUSEY C JR (DDS, PA)
Entity Type:Individual
Prefix:
First Name:CAUSEY
Middle Name:C
Last Name:LEE
Suffix:JR
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4640 N FEDERAL HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-5205
Mailing Address - Country:US
Mailing Address - Phone:954-493-9755
Mailing Address - Fax:954-493-5477
Practice Address - Street 1:4640 N FEDERAL HWY
Practice Address - Street 2:SUITE A
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-5205
Practice Address - Country:US
Practice Address - Phone:954-493-9755
Practice Address - Fax:954-493-5477
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN52241223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics