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General NPI Number Information
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NPI Number | 1720201205
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Entity Type | Organization
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Legal Business Name | VINGELIS AND LEE FAMILY DENTAL
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 05/02/2011
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Provider Practice Location Address
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Address Line | 145 OAKDALE ROAD SUITE A
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City | JOHNSON CITY
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State | NY
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Zip | 13790-1766
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Country | US
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Telephone | 607-217-5853
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Fax | 607-237-0159
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Provider Business Mailing Address
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Address Line | 145 OAKDALE ROAD SUITE A
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City | JOHNSON CITY
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State | NY
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Zip | 13790-1766
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Country | US
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Telephone | 607-217-5853
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Fax | 607-237-0159
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. TIMOTHY JEROME LEE
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Credential | DDS
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Telephone | 607-754-1999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 047633-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 046853-1
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License Number State | NY
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