Healthcare Provider Details

I. General information

NPI: 1821293648
Provider Name (Legal Business Name): RICHARD J. LEE DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 08/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 SANDUSKY ST
FOSTORIA OH
44830-2747
US

IV. Provider business mailing address

801 SANDUSKY ST
FOSTORIA OH
44830-2747
US

V. Phone/Fax

Practice location:
  • Phone: 419-453-1842
  • Fax: 419-435-4670
Mailing address:
  • Phone: 419-453-1842
  • Fax: 419-435-4670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD J LEE
Title or Position: PRESIDENT
Credential: DDS
Phone: 419-435-1842