Provider Demographics
NPI:1720201205
Name:VINGELIS AND LEE FAMILY DENTAL
Entity Type:Organization
Organization Name:VINGELIS AND LEE FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:607-754-1999
Mailing Address - Street 1:145 OAKDALE ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-1766
Mailing Address - Country:US
Mailing Address - Phone:607-217-5853
Mailing Address - Fax:607-237-0159
Practice Address - Street 1:145 OAKDALE ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-1766
Practice Address - Country:US
Practice Address - Phone:607-217-5853
Practice Address - Fax:607-237-0159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046853-11223G0001X
NY047633-11223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty