Healthcare Provider Details

I. General information

NPI: 1780503987
Provider Name (Legal Business Name): SEUNG YEOB LEE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3693 KIDRON RD
KIDRON OH
44636-0020
US

IV. Provider business mailing address

3693 KIDRON RD
KIDRON OH
44636-0020
US

V. Phone/Fax

Practice location:
  • Phone: 330-857-0144
  • Fax:
Mailing address:
  • Phone: 330-857-0144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.028483
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: