Provider Demographics
NPI:1982718490
Name:LEE, MICHAEL B (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:B
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 1:7523 STATE RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45255-2438
Mailing Address - Country:US
Mailing Address - Phone:513-232-8989
Mailing Address - Fax:513-232-1405
Practice Address - Street 1:7523 STATE RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-2438
Practice Address - Country:US
Practice Address - Phone:513-232-8989
Practice Address - Fax:513-232-1405
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH16003204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0501112Medicare ID - Type Unspecified
OHT47349Medicare UPIN