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General NPI Number Information
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NPI Number | 1841189008
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Entity Type | Individual
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Provider Name | BRANDON LEE DMD
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Gender | Male
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Dates
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Enumeration Date | 07/01/2025
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 9200 113TH ST
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City | SEMINOLE
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State | FL
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Zip | 33772-2800
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Country | US
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Telephone | 727-893-5050
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Fax |
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Provider Business Mailing Address
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Address Line | 1107 ROSERY RD NW APT 4302
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City | LARGO
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State | FL
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Zip | 33770-1265
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Country | US
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Telephone | 904-441-9334
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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 | DN30832
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License Number State | FL
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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 | 2919
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License Number State | FL
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