Provider Demographics
NPI:1083581821
Name:DR. DWIGHT B. LEE FAMILY & COSMETIC DENTISTRY, INC.
Entity type:Organization
Organization Name:DR. DWIGHT B. LEE FAMILY & COSMETIC DENTISTRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-482-2400
Mailing Address - Street 1:1202 N LEBANON ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:46052-1510
Mailing Address - Country:US
Mailing Address - Phone:765-482-2400
Mailing Address - Fax:765-482-2405
Practice Address - Street 1:1202 N LEBANON ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-1510
Practice Address - Country:US
Practice Address - Phone:765-482-2400
Practice Address - Fax:765-482-2405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-17
Last Update Date:2025-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty