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General NPI Number Information
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NPI Number | 1972721876
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Entity Type | Organization
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Legal Business Name | PEDIATRIC DENTISTRY OF LITCHFIELD COUNTY, LLC
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 148 MIGEON AVE
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City | TORRINGTON
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State | CT
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Zip | 06790-4817
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Country | US
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Telephone | 860-482-9578
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Fax |
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Provider Business Mailing Address
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Address Line | 148 MIGEON AVE
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City | TORRINGTON
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State | CT
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Zip | 06790-4817
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Country | US
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Telephone | 860-482-9578
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. LAWRENCE YING LEE
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Credential | D.D.S.
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Telephone | 860-482-9578
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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 | 009402
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License Number State | CT
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