Provider Demographics
NPI:1700333085
Name:FURA, LEE
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:FURA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 JASONS WAY
Mailing Address - Street 2:
Mailing Address - City:ANNVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17003-2037
Mailing Address - Country:US
Mailing Address - Phone:717-867-5088
Mailing Address - Fax:
Practice Address - Street 1:1 JASONS WAY
Practice Address - Street 2:
Practice Address - City:ANNVILLE
Practice Address - State:PA
Practice Address - Zip Code:17003-2037
Practice Address - Country:US
Practice Address - Phone:717-867-5088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-05
Last Update Date:2017-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040848122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist