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General NPI Number Information
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NPI Number | 1760741318
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Entity Type | Individual
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Provider Name | EUNICE DONGYOON LEE D.M.D
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Gender | Female
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Dates
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Enumeration Date | 05/15/2012
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Last Update Date | 12/07/2022
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Provider Practice Location Address
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Address Line | 2480 BLACK ROCK TPKE STE 1
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City | FAIRFIELD
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State | CT
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Zip | 06825-2406
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Country | US
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Telephone | 203-763-4200
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Fax | 203-763-4232
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Provider Business Mailing Address
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Address Line | 2480 BLACK ROCK TPKE STE 1
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City | FAIRFIELD
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State | CT
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Zip | 06825-2406
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Country | US
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Telephone | 203-763-4200
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Fax | 203-763-4232
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 2.011229
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License Number State | CT
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