Healthcare Provider Details

I. General information

NPI: 1659923969
Provider Name (Legal Business Name): SUNHEE LEE DMD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2019
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DEWOLF RD STE 102
OLD TAPPAN NJ
07675-7084
US

IV. Provider business mailing address

1 DEWOLF RD STE 102
OLD TAPPAN NJ
07675-7084
US

V. Phone/Fax

Practice location:
  • Phone: 201-767-1441
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: SUNHEE LEE
Title or Position: OWNER
Credential:
Phone: 201-370-3897