Healthcare Provider Details

I. General information

NPI: 1992003644
Provider Name (Legal Business Name): MENG-CHIEH LEE, DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2011
Last Update Date: 03/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CUMMINGS CTR SUITE 128Q
BEVERLY MA
01915-6115
US

IV. Provider business mailing address

100 CUMMINGS CTR SUITE 128Q
BEVERLY MA
01915-6115
US

V. Phone/Fax

Practice location:
  • Phone: 978-232-9003
  • Fax: 978-232-9034
Mailing address:
  • Phone: 978-232-9003
  • Fax: 978-232-9034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number21714
License Number StateMA

VIII. Authorized Official

Name: DR. MENG-CHIEH LEE
Title or Position: PRESIDENT
Credential:
Phone: 617-383-4197