Provider Demographics
NPI:1598268039
Name:LEE, SAMUEL ROBERT (DMD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:ROBERT
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 1:104 TREMONT ST STE 2
Mailing Address - Street 2:
Mailing Address - City:DUXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02332-4750
Mailing Address - Country:US
Mailing Address - Phone:781-934-2300
Mailing Address - Fax:781-934-0247
Practice Address - Street 1:104 TREMONT ST STE 2
Practice Address - Street 2:
Practice Address - City:DUXBURY
Practice Address - State:MA
Practice Address - Zip Code:02332-4750
Practice Address - Country:US
Practice Address - Phone:781-934-2300
Practice Address - Fax:781-934-0247
Is Sole Proprietor?:No
Enumeration Date:2018-03-12
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18590191223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics