MEDICARE: EUNICE DONGYOON 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	1223P0221X	Pediatric Dentistry	2.011229	CT

General Provider Information

NPI Number	:	1760741318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUNICE DONGYOON LEE D.M.D

Provider Business Mailing Address
First Line	:	2480 BLACK ROCK TPKE STE 1
Second Line	:
City	:	FAIRFIELD
State	:	CT
Zip	:	06825-2406
Country	:	US
Telephone Number	:	203-763-4200
Fax Number	:	203-763-4232

Provider Business Practice Location Address
First Line	:	2480 BLACK ROCK TPKE STE 1
Second Line	:
City	:	FAIRFIELD
State	:	CT
Zip	:	06825-2406
Country	:	US
Telephone Number	:	203-763-4200
Fax Number	:	203-763-4232

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

Provider Enumeration Date	:	05/15/2012
Last Update Date	:	12/07/2022

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