Provider Demographics
NPI:1336532712
Name:LEE, SOONJAE JOSEPH (DMD)
Entity Type:Individual
Prefix:DR
First Name:SOONJAE
Middle Name:JOSEPH
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 1:1710 E LANCASTER AVE # 311
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1507
Mailing Address - Country:US
Mailing Address - Phone:267-270-5658
Mailing Address - Fax:
Practice Address - Street 1:1710 E LANCASTER AVE # 311
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1507
Practice Address - Country:US
Practice Address - Phone:267-270-5658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-10
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI026594001223D0004X
PADS0402811223D0004X, 1223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDentist Anesthesiologist