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General NPI Number Information
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NPI Number | 1649044439
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Entity Type | Individual
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Provider Name | I-TING LEE
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Gender | Male
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Dates
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Enumeration Date | 11/13/2023
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Last Update Date | 11/13/2023
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Provider Practice Location Address
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Address Line | 13 BONESET TRL APT F
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City | NORTH CHILI
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State | NY
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Zip | 14514-9627
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Country | US
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Telephone | 734-210-4520
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Fax |
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Provider Business Mailing Address
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Address Line | 13 BONESET TRL APT F
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City | NORTH CHILI
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State | NY
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Zip | 14514-9627
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Country | US
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Telephone | 734-210-4520
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Fax |
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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 | 016.0134229
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License Number State | VT
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