Healthcare Provider Details

I. General information

NPI: 1215719430
Provider Name (Legal Business Name): SAMUEL LEE DMD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 10/23/2023
Certification Date: 10/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 COUNTY RD
HANSON MA
02341-1668
US

IV. Provider business mailing address

27 HOWLAND ST UNIT 8
PLYMOUTH MA
02360-4998
US

V. Phone/Fax

Practice location:
  • Phone: 781-294-8022
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SAMUEL ROBERT LEE
Title or Position: PRESIDENT
Credential: DMD
Phone: 407-375-7176