Provider Demographics
NPI:1831400555
Name:LEE, JOSHUA JAE-JOON (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:JAE-JOON
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 1:279 CAMBRIDGE ST STE 9
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-2549
Mailing Address - Country:US
Mailing Address - Phone:781-272-5080
Mailing Address - Fax:
Practice Address - Street 1:279 CAMBRIDGE ST STE 9
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803
Practice Address - Country:US
Practice Address - Phone:781-272-5080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL10953122300000X
MADN1856039122300000X, 1223P0700X
MADN19560391223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist