Healthcare Provider Details

I. General information

NPI: 1851698815
Provider Name (Legal Business Name): RYAN S LEE DDS, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2011
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 NICHOLS RD
FITCHBURG MA
01420-1914
US

IV. Provider business mailing address

326 NICHOLS RD
FITCHBURG MA
01420-1914
US

V. Phone/Fax

Practice location:
  • Phone: 978-878-8100
  • Fax:
Mailing address:
  • Phone: 978-878-8100
  • Fax: 401-444-0468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1856786
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number055672
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI02464000
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1856786
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI02464000
License Number StateNJ
# 6
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number22DI02464000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: