Provider Demographics
NPI:1689877540
Name:LEE, ANN S (DDS)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:S
Last Name:LEE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 RIVERSIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905
Mailing Address - Country:US
Mailing Address - Phone:607-798-0271
Mailing Address - Fax:
Practice Address - Street 1:1118 CHARLES ST
Practice Address - Street 2:UCP DIAGNOSTIC & TREATMENT CENTER
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14902-1554
Practice Address - Country:US
Practice Address - Phone:607-734-7107
Practice Address - Fax:607-734-9708
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035305122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist