Provider Demographics
NPI:1760741318
Name:LEE, EUNICE DONGYOON (DMD)
Entity Type:Individual
Prefix:
First Name:EUNICE
Middle Name:DONGYOON
Last Name:LEE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2480 BLACK ROCK TPKE STE 1
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-2406
Mailing Address - Country:US
Mailing Address - Phone:203-763-4200
Mailing Address - Fax:203-763-4232
Practice Address - Street 1:2480 BLACK ROCK TPKE STE 1
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-2406
Practice Address - Country:US
Practice Address - Phone:203-763-4200
Practice Address - Fax:203-763-4232
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-15
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2.0112291223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry