Provider Demographics
NPI:1659361566
Name:LEE, RICHARD ERIK (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ERIK
Last Name:LEE
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 1:1002 S RACE ST
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-4957
Mailing Address - Country:US
Mailing Address - Phone:217-531-4281
Mailing Address - Fax:217-352-0126
Practice Address - Street 1:710 N NEIL ST
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-3013
Practice Address - Country:US
Practice Address - Phone:217-352-7961
Practice Address - Fax:217-352-0126
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health