MEDICARE: DR. DESIRAE LEE DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1023965753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DESIRAE LEE DMD

Provider Business Mailing Address
First Line	:	3600 FORBES AVENUE
Second Line	:	FORBES TOWER: PLAZA LEVEL SUITE 140
City	:	PITTSBURGH
State	:	PA
Zip	:	15213
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4401 PENN AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15224-1334
Country	:	US
Telephone Number	:	412-692-6805
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2026
Last Update Date	:	03/12/2026

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