Healthcare Provider Details

I. General information

NPI: 1992129977
Provider Name (Legal Business Name): LEE W. MCNEISH DMD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2014
Last Update Date: 02/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 CHASE PKWY
WATERBURY CT
06708-3046
US

IV. Provider business mailing address

650 CHASE PKWY
WATERBURY CT
06708-3046
US

V. Phone/Fax

Practice location:
  • Phone: 203-596-7788
  • Fax: 203-596-7194
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number7227
License Number StateCT

VIII. Authorized Official

Name: DR. LEE W MCNEISH
Title or Position: OWNER
Credential:
Phone: 203-596-7788