Provider Demographics
NPI:1295289395
Name:LEE, KUGUN (DMD)
Entity type:Individual
Prefix:DR
First Name:KUGUN
Middle Name:
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 1:103 MERRIMACK ST
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-6208
Mailing Address - Country:US
Mailing Address - Phone:978-971-0060
Mailing Address - Fax:978-971-0061
Practice Address - Street 1:103 MERRIMACK ST
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-6208
Practice Address - Country:US
Practice Address - Phone:978-971-0060
Practice Address - Fax:978-971-0061
Is Sole Proprietor?:No
Enumeration Date:2016-08-07
Last Update Date:2023-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18573541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice