Provider Demographics
NPI:1205930609
Name:LEE, ANTONY A (DMD)
Entity type:Individual
Prefix:DR
First Name:ANTONY
Middle Name:A
Last Name:LEE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 ORIENTA AVE
Mailing Address - Street 2:SUITE 1081
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-5675
Mailing Address - Country:US
Mailing Address - Phone:407-629-8005
Mailing Address - Fax:407-629-8009
Practice Address - Street 1:745 ORIENTA AVE
Practice Address - Street 2:SUITE 1081
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-5675
Practice Address - Country:US
Practice Address - Phone:407-629-8005
Practice Address - Fax:407-629-8009
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN156881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice