Provider Demographics
NPI:1013997519
Name:LEE, JEFFERY S (DDS MS)
Entity type:Individual
Prefix:MR
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 1:510 ARENDS RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750
Mailing Address - Country:US
Mailing Address - Phone:740-236-9392
Mailing Address - Fax:740-439-0894
Practice Address - Street 1:510 ARENDS RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750
Practice Address - Country:US
Practice Address - Phone:740-236-9392
Practice Address - Fax:740-439-0894
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0218021223S0112X
OH30021802122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0230158Medicaid