Provider Demographics
NPI:1013997519
Name:LEE, JEFFERY S (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:S
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7297 JOHN GLENN HWY
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-9034
Mailing Address - Country:US
Mailing Address - Phone:740-432-8768
Mailing Address - Fax:740-439-0894
Practice Address - Street 1:7297 JOHN GLENN HWY
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-9034
Practice Address - Country:US
Practice Address - Phone:740-432-8768
Practice Address - Fax:740-439-0894
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0218021223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHV11508Medicare UPIN