Provider Demographics
NPI:1932394103
Name:LEE, IN
Entity Type:Individual
Prefix:DR
First Name:IN
Middle Name:
Last Name:LEE
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 1:2755 CARPENTER RD
Mailing Address - Street 2:SUITE 1 NE
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1186
Mailing Address - Country:US
Mailing Address - Phone:734-971-2980
Mailing Address - Fax:734-971-2680
Practice Address - Street 1:2755 CARPENTER RD
Practice Address - Street 2:SUITE 1 NE
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1186
Practice Address - Country:US
Practice Address - Phone:734-971-2980
Practice Address - Fax:734-971-2680
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI145781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice