Healthcare Provider Details

I. General information

NPI: 1750821427
Provider Name (Legal Business Name): BINNA LEE DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2017
Last Update Date: 08/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

389 MAIN ST STE 403
MALDEN MA
02148-5017
US

IV. Provider business mailing address

389 MAIN ST STE 403
MALDEN MA
02148-5017
US

V. Phone/Fax

Practice location:
  • Phone: 781-397-9229
  • Fax:
Mailing address:
  • Phone: 781-397-9229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN1857988
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: