Provider Demographics
NPI:1609094408
Name:FROST, LEE THOMAS (DDS)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:THOMAS
Last Name:FROST
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 OLD FARM RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-4121
Mailing Address - Country:US
Mailing Address - Phone:973-403-8521
Mailing Address - Fax:
Practice Address - Street 1:75 ORIENT WAY
Practice Address - Street 2:SUITE 203
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-2011
Practice Address - Country:US
Practice Address - Phone:201-438-8870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ148281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJAF2852760OtherDEA NUMBER