MEDICARE: SOO S. LEE D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DS035433	PA

General Provider Information

NPI Number	:	1033131297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOO S. LEE D.M.D.

Provider Business Mailing Address
First Line	:	1431 WESLEYS RUN
Second Line	:
City	:	GLADWYNE
State	:	PA
Zip	:	19035-1049
Country	:	US
Telephone Number	:	610-613-9177
Fax Number	:

Provider Business Practice Location Address
First Line	:	219 W MAIN ST
Second Line	:
City	:	TRAPPE
State	:	PA
Zip	:	19426-2000
Country	:	US
Telephone Number	:	610-489-8331
Fax Number	:	610-489-1563

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	12/09/2010

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