Healthcare Provider Details

I. General information

NPI: 1013997519
Provider Name (Legal Business Name): JEFFERY S. LEE DDS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 09/17/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 ARENDS RIDGE ROAD
MARIETTA OH
45750
US

IV. Provider business mailing address

510 ARENDS RIDGE ROAD
MARIETTA OH
45750
US

V. Phone/Fax

Practice location:
  • Phone: 740-236-9392
  • Fax: 740-439-0894
Mailing address:
  • Phone: 740-236-9392
  • Fax: 740-439-0894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30021802
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number30.021802
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: