MEDICARE: BOO S LEE DDS

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	8211	NC
2	1223P0221X	Pediatric Dentistry	8211	NC

General Provider Information

NPI Number	:	1952581712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BOO S LEE DDS

Provider Business Mailing Address
First Line	:	2106 WERRINGTON DR
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-3330
Country	:	US
Telephone Number	:	919-762-7013
Fax Number	:

Provider Business Practice Location Address
First Line	:	2106 WERRINGTON DR
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-3330
Country	:	US
Telephone Number	:	919-762-7013
Fax Number	:

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

Provider Enumeration Date	:	11/09/2007
Last Update Date	:	03/29/2023

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Directions to “ BOO S LEE DDS” Practice Location

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