Provider Demographics
NPI:1750765111
Name:LEE, GYUHO (DDS)
Entity type:Individual
Prefix:DR
First Name:GYUHO
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:ALEX
Other - Middle Name:G
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1500 LOCUST ST APT 3004
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-4322
Mailing Address - Country:US
Mailing Address - Phone:609-558-5097
Mailing Address - Fax:
Practice Address - Street 1:1325 W AIRY ST
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-4357
Practice Address - Country:US
Practice Address - Phone:610-275-1565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040534122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist