Healthcare Provider Details

I. General information

NPI: 1992626428
Provider Name (Legal Business Name): HANS LEE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 LECOM WAY
DEFUNIAK SPRINGS FL
32435-6323
US

IV. Provider business mailing address

205 HAMMOCK TRL E APT M311
FREEPORT FL
32439-7714
US

V. Phone/Fax

Practice location:
  • Phone: 850-951-0200
  • Fax:
Mailing address:
  • Phone: 503-752-4538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN32306
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: