MEDICARE: DR. EDWARD HENRY LEE DMD

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	054950	NY

General Provider Information

NPI Number	:	1619102118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD HENRY LEE DMD

Provider Business Mailing Address
First Line	:	506 3RD ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-3097
Country	:	US
Telephone Number	:	718-962-0808
Fax Number	:

Provider Business Practice Location Address
First Line	:	506 3RD ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-3097
Country	:	US
Telephone Number	:	718-962-0808
Fax Number	:

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

Provider Enumeration Date	:	05/27/2009
Last Update Date	:	05/09/2023

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