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General NPI Number Information
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NPI Number | 1972350817
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Entity Type | Individual
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Provider Name | ANDREW LEE
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Gender | Male
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Dates
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Enumeration Date | 04/30/2024
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Last Update Date | 09/23/2024
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Provider Practice Location Address
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Address Line | 188 LONGWOOD AVE
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City | BOSTON
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State | MA
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Zip | 02115
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Country | US
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Telephone | 617-461-7432
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Fax |
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Provider Business Mailing Address
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Address Line | 140 WHITWELL ST APT 426
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City | QUINCY
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State | MA
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Zip | 02169-1996
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Country | US
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Telephone | 949-701-7211
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN10000306
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License Number State | MA
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