Provider Demographics
NPI:1942476254
Name:LEE, ANDREW L (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:L
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 1:1159 ULSTER AVE
Mailing Address - Street 2:ASPEN DENTAL
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401
Mailing Address - Country:US
Mailing Address - Phone:845-481-1584
Mailing Address - Fax:845-336-6712
Practice Address - Street 1:1159 ULSTER AVE
Practice Address - Street 2:ASPEN DENTAL
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-1513
Practice Address - Country:US
Practice Address - Phone:845-481-1584
Practice Address - Fax:845-336-6712
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054353-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice