=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437237195
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL J. LEE DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 127 E MAIN ST # 131
-----------------------------------------------------
City | MIDDLETOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10940-5118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-342-5866
-----------------------------------------------------
Fax | 845-343-3802
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23 DAVIDGE RD
-----------------------------------------------------
City | MIDDLETOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10940-4643
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-342-5866
-----------------------------------------------------
Fax | 845-343-3802
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 050528
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------