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General NPI Number Information
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NPI Number | 1003031402
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Entity Type | Individual
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Provider Name | DAVID FORMOSAN LEE DDS
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Gender | Male
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 06/08/2020
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Provider Practice Location Address
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Address Line | 30 E 40TH ST RM 305
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City | NEW YORK
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State | NY
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Zip | 10016-1247
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Country | US
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Telephone | 212-370-1919
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Fax |
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Provider Business Mailing Address
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Address Line | 4436 TIMBERLAKE DRIVE
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City | LOUISVILLE
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State | TN
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Zip | 37777
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Country | US
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Telephone | 865-970-2821
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Fax | 865-983-0870
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 50 053083
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License Number State | NY
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