Healthcare Provider Details

I. General information

NPI: 1780510446
Provider Name (Legal Business Name): EUNICE LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 W GOLF RD
MOUNT PROSPECT IL
60056-4071
US

IV. Provider business mailing address

602 SHAWN LN
PROSPECT HEIGHTS IL
60070-1664
US

V. Phone/Fax

Practice location:
  • Phone: 847-357-9850
  • Fax:
Mailing address:
  • Phone: 630-246-0795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.037202
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: