MEDICARE: SEUNG 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	1223P0300X	Periodontics	16382	FL

General Provider Information

NPI Number	:	1649323841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEUNG LEE D.M.D.

Provider Business Mailing Address
First Line	:	7009 DR PHILLIPS BLVD
Second Line	:	SUITE #200
City	:	ORLANDO
State	:	FL
Zip	:	32819-5123
Country	:	US
Telephone Number	:	407-248-2828
Fax Number	:	407-248-2850

Provider Business Practice Location Address
First Line	:	7009 DR PHILLIPS BLVD
Second Line	:	SUITE #200
City	:	ORLANDO
State	:	FL
Zip	:	32819-5123
Country	:	US
Telephone Number	:	407-248-2828
Fax Number	:	407-248-2850

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

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	02/04/2010

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