Provider Demographics
NPI:1245279793
Name:LEE, ROBERT MARK (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MARK
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 1:34 N ISLAND AVE
Mailing Address - Street 2:SUITE H
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-1971
Mailing Address - Country:US
Mailing Address - Phone:630-879-0055
Mailing Address - Fax:630-879-7755
Practice Address - Street 1:34 N ISLAND AVE
Practice Address - Street 2:SUITE H
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-1971
Practice Address - Country:US
Practice Address - Phone:630-879-0055
Practice Address - Fax:630-879-7755
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist