MEDICARE: CAUSEY C. LEE, D.D.S., P.A.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DN5224	FL

General Provider Information

NPI Number	:	1457578700
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAUSEY C. LEE, D.D.S., P.A.

Provider Business Mailing Address
First Line	:	1790 W 49TH ST
Second Line	:	SUITE 110
City	:	HIALEAH
State	:	FL
Zip	:	33012-2992
Country	:	US
Telephone Number	:	305-558-3384
Fax Number	:	305-828-5726

Provider Business Practice Location Address
First Line	:	1790 W 49TH ST
Second Line	:	SUITE 110
City	:	HIALEAH
State	:	FL
Zip	:	33012-2992
Country	:	US
Telephone Number	:	305-558-3384
Fax Number	:	305-828-5726

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CAUSEY C. LEE JR.
Credential	:	D.D.S., P.A.
Telephone Number	:	305-558-3384

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	08/22/2020

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