Healthcare Provider Details

I. General information

NPI: 1487132320
Provider Name (Legal Business Name): RICHARD C LEE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2018
Last Update Date: 07/02/2020
Certification Date: 07/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 CHERRY ST
MILFORD CT
06460-3413
US

IV. Provider business mailing address

16 SANDBURG CT
TEANECK NJ
07666-6483
US

V. Phone/Fax

Practice location:
  • Phone: 203-878-4757
  • Fax:
Mailing address:
  • Phone: 201-561-2752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number34472
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12771
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: