Provider Demographics
NPI:1932150042
Name:LEE, BENJAMIN G (DDS)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:G
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:387 N. WOODLAWN
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-4330
Mailing Address - Country:US
Mailing Address - Phone:316-685-2309
Mailing Address - Fax:316-685-1596
Practice Address - Street 1:387 N. WOODLAWN
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-4330
Practice Address - Country:US
Practice Address - Phone:316-685-2309
Practice Address - Fax:316-685-1596
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-13
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS601261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice