Healthcare Provider Details

I. General information

NPI: 1912824277
Provider Name (Legal Business Name): HORYEONG LEE DENTAL, P. A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 E FLETCHER AVE
TAMPA FL
33612-3574
US

IV. Provider business mailing address

912 E FLETCHER AVE
TAMPA FL
33612-3574
US

V. Phone/Fax

Practice location:
  • Phone: 813-816-0132
  • Fax:
Mailing address:
  • Phone: 813-816-0132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. HORYEONG LEE
Title or Position: DENTIST
Credential: DMD
Phone: 256-924-4226