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General NPI Number Information
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NPI Number | 1215634886
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Entity Type | Organization
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Legal Business Name | DERBYDDS, P.C.
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Dates
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Enumeration Date | 02/14/2023
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Last Update Date | 03/27/2023
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Provider Practice Location Address
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Address Line | 49 PERSHING DR STE 5A
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City | DERBY
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State | CT
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Zip | 06418-1406
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Country | US
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Telephone | 203-800-9757
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Fax |
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Provider Business Mailing Address
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Address Line | 49 PERSHING DR STE 5A
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City | DERBY
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State | CT
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Zip | 06418-1406
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Country | US
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Telephone | 203-800-9757
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. IN KYUNG LEE
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Credential |
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Telephone | 201-820-5053
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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 |
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License Number State |
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