Provider Demographics
NPI:1851555171
Name:LEE, YOUNG HAWKE (DDS)
Entity Type:Individual
Prefix:
First Name:YOUNG
Middle Name:HAWKE
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 1:2229 W WALNUT STREET
Mailing Address - Street 2:
Mailing Address - City:COLMAR
Mailing Address - State:PA
Mailing Address - Zip Code:18915
Mailing Address - Country:US
Mailing Address - Phone:734-474-0965
Mailing Address - Fax:
Practice Address - Street 1:1901 RIDGEWOOD ROAD
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610
Practice Address - Country:US
Practice Address - Phone:610-373-3720
Practice Address - Fax:610-373-7014
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-022752122300000X
PADS0386111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2837596Medicaid