Provider Demographics
NPI:1336440247
Name:LEE, BRIAN I (DMD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:I
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 1:10850 71ST AVE STE 1G
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4524
Mailing Address - Country:US
Mailing Address - Phone:718-268-3666
Mailing Address - Fax:718-268-7785
Practice Address - Street 1:10850 71ST AVE STE 1G
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4524
Practice Address - Country:US
Practice Address - Phone:718-268-3666
Practice Address - Fax:718-268-7785
Is Sole Proprietor?:No
Enumeration Date:2010-11-09
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0571341223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics