Healthcare Provider Details

I. General information

NPI: 1831591858
Provider Name (Legal Business Name): BRIAN LEE, DMD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2014
Last Update Date: 09/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 OXFORD VALLEY RD SUITE 601A
YARDLEY PA
19067-7706
US

IV. Provider business mailing address

301 OXFORD VALLEY RD SUITE 601A
YARDLEY PA
19067-7706
US

V. Phone/Fax

Practice location:
  • Phone: 215-550-7186
  • Fax: 215-646-6166
Mailing address:
  • Phone: 215-550-7186
  • Fax: 215-646-6166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS038507
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. BRIAN LEE
Title or Position: OWNER
Credential: DMD
Phone: 215-550-7186