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General NPI Number Information
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NPI Number | 1811073521
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Entity Type | Individual
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Provider Name | CHONG SONG LEE D.M.D.,M.M.SC.
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Gender | Male
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 172 N DARTMOUTH MALL
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City | NORTH DARTMOUTH
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State | MA
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Zip | 02747-4204
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Country | US
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Telephone | 508-996-3360
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Fax |
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Provider Business Mailing Address
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Address Line | 1579 CENTRE ST
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City | NEWTON
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State | MA
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Zip | 02461-1256
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Country | US
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Telephone | 408-244-1068
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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 | 18866
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License Number State | MA
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