Healthcare Provider Details

I. General information

NPI: 1265109433
Provider Name (Legal Business Name): PURE COSMETIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2021
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 VILLAGE SQ
CHELMSFORD MA
01824-2712
US

IV. Provider business mailing address

15 VILLAGE SQ
CHELMSFORD MA
01824-2712
US

V. Phone/Fax

Practice location:
  • Phone: 978-800-1680
  • Fax: 978-455-4526
Mailing address:
  • Phone: 978-800-1680
  • Fax: 978-455-4526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID T LEE
Title or Position: OWNER/CEO
Credential: MD
Phone: 408-837-8860