Healthcare Provider Details

I. General information

NPI: 1154826121
Provider Name (Legal Business Name): ALEXANDER LEE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2191 PARK AVE W
ONTARIO OH
44906-1226
US

IV. Provider business mailing address

6372 SKIPPING STONE DR
NEW ALBANY OH
43054-5024
US

V. Phone/Fax

Practice location:
  • Phone: 419-529-9494
  • Fax: 419-529-9391
Mailing address:
  • Phone: 614-439-5901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number30.027426
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS042448
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: