MEDICARE: DR. CHONG SONG LEE D.M.D.,M.M.SC.

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	18866	MA

General Provider Information

NPI Number	:	1811073521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHONG SONG LEE D.M.D.,M.M.SC.

Provider Business Mailing Address
First Line	:	1579 CENTRE ST
Second Line	:
City	:	NEWTON
State	:	MA
Zip	:	02461-1256
Country	:	US
Telephone Number	:	408-244-1068
Fax Number	:

Provider Business Practice Location Address
First Line	:	172 N DARTMOUTH MALL
Second Line	:
City	:	NORTH DARTMOUTH
State	:	MA
Zip	:	02747-4204
Country	:	US
Telephone Number	:	508-996-3360
Fax Number	:

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

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	07/08/2007

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