Provider Demographics
NPI:1740301027
Name:LEE, JANICE C (DMD)
Entity type:Individual
Prefix:DR
First Name:JANICE
Middle Name:C
Last Name:LEE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MRS
Other - First Name:JANICE
Other - Middle Name:LEE
Other - Last Name:SWAIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8 BUSINESS PARK CT
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-6308
Mailing Address - Country:US
Mailing Address - Phone:315-732-6719
Mailing Address - Fax:315-738-7140
Practice Address - Street 1:8 BUSINESS PARK CT
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-6308
Practice Address - Country:US
Practice Address - Phone:315-732-6719
Practice Address - Fax:315-738-7140
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0384391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01322054Medicaid