Provider Demographics
NPI:1851874945
Name:EUGENE LEE, DDS., PC
Entity Type:Organization
Organization Name:EUGENE LEE, DDS., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANG
Authorized Official - Prefix:
Authorized Official - First Name:MARITZA
Authorized Official - Middle Name:
Authorized Official - Last Name:DURAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-229-1441
Mailing Address - Street 1:636A WANTAGH AVE
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-5325
Mailing Address - Country:US
Mailing Address - Phone:516-450-5159
Mailing Address - Fax:516-706-9288
Practice Address - Street 1:636A WANTAGH AVE
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-5325
Practice Address - Country:US
Practice Address - Phone:516-450-5159
Practice Address - Fax:516-706-9288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2405163Medicaid