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General NPI Number Information
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NPI Number | 1710479795
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Entity Type | Individual
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Provider Name | LEE HOANG MAI DMD
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Gender | Male
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Dates
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Enumeration Date | 06/05/2018
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Last Update Date | 08/29/2022
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Provider Practice Location Address
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Address Line | 505 SQUIRES PT
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City | DUNCAN
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State | SC
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Zip | 29334-8867
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Country | US
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Telephone | 864-433-6888
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Fax |
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Provider Business Mailing Address
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Address Line | 230 NORTHGATE CIR
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City | BOILING SPRINGS
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State | SC
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Zip | 29316-5741
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Country | US
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Telephone | 864-266-9858
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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 | 10804043-9922
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 10302
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License Number State | SC
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