Healthcare Provider Details

I. General information

NPI: 1437076817
Provider Name (Legal Business Name): DR. JUSTIN LEE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

201 BUS TERMINAL RD
OAK RIDGE TN
37830-6903
US

IV. Provider business mailing address

11615 LANESBOROUGH WAY APT 616
FARRAGUT TN
37934-1689
US

V. Phone/Fax

Practice location:
  • Phone: 865-483-1323
  • Fax:
Mailing address:
  • Phone: 865-483-1323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number13274
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: