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General NPI Number Information
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NPI Number | 1538675988
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Entity Type | Organization
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Legal Business Name | YOOSEOK LEE DDS PC
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Dates
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Enumeration Date | 12/21/2017
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Last Update Date | 12/21/2017
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Provider Practice Location Address
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Address Line | 637 MAIN ST
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City | POUGHKEEPSIE
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State | NY
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Zip | 12601-3836
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Country | US
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Telephone | 845-452-6110
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Fax | 845-452-6112
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Provider Business Mailing Address
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Address Line | 637 MAIN ST
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City | POUGHKEEPSIE
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State | NY
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Zip | 12601-3836
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Country | US
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Telephone | 845-452-6110
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. YOOSEOK LEE
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Credential | DDS
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Telephone | 201-370-5414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 050449
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License Number State | NY
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