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General NPI Number Information
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NPI Number | 1528579273
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Entity Type | Organization
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Legal Business Name | KIWON LEE, D.D.S., PC
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Dates
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Enumeration Date | 10/21/2017
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Last Update Date | 03/08/2018
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Provider Practice Location Address
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Address Line | 305 W GRAND AVE STE 100
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City | MONTVALE
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State | NJ
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Zip | 07645-1813
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Country | US
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Telephone | 201-746-9474
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Fax |
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Provider Business Mailing Address
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Address Line | 305 W GRAND AVE STE 100
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City | MONTVALE
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State | NJ
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Zip | 07645-1813
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Country | US
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Telephone | 201-746-9474
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING ASSISITANT
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Name | MRS. MARITZA DURAN
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Credential |
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Telephone | 516-229-1441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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