Provider Demographics
NPI:1649323841
Name:LEE, SEUNG (DMD)
Entity type:Individual
Prefix:
First Name:SEUNG
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:CHRISTOPHER
Other - Middle Name:SEUNG
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:7009 DR PHILLIPS BLVD
Mailing Address - Street 2:SUITE #200
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5123
Mailing Address - Country:US
Mailing Address - Phone:407-248-2828
Mailing Address - Fax:407-248-2850
Practice Address - Street 1:7009 DR PHILLIPS BLVD
Practice Address - Street 2:SUITE #200
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5123
Practice Address - Country:US
Practice Address - Phone:407-248-2828
Practice Address - Fax:407-248-2850
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL163821223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics