MEDICARE: JAMES LEE DDS

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	122300000X	Dentist	30.025774	OH

General Provider Information

NPI Number	:	1306404710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES LEE DDS

Provider Business Mailing Address
First Line	:	1307 SPAGNOL LN
Second Line	:
City	:	WESTERVILLE
State	:	OH
Zip	:	43081-7527
Country	:	US
Telephone Number	:	614-940-0318
Fax Number	:

Provider Business Practice Location Address
First Line	:	4490 INDIANOLA AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-2244
Country	:	US
Telephone Number	:	614-262-8180
Fax Number	:	614-262-2883

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

Provider Enumeration Date	:	05/31/2019
Last Update Date	:	01/31/2023

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