MEDICARE: D. H. LEE DMD PA

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	1223G0001X	General Practice Dentistry	NC 9417	NC

General Provider Information

NPI Number	:	1164833620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	D. H. LEE DMD PA

Provider Business Mailing Address
First Line	:	109 JOLLY ST
Second Line	:
City	:	LOUISBURG
State	:	NC
Zip	:	27549-2239
Country	:	US
Telephone Number	:	919-496-5734
Fax Number	:	919-496-2599

Provider Business Practice Location Address
First Line	:	109 JOLLY ST
Second Line	:
City	:	LOUISBURG
State	:	NC
Zip	:	27549-2239
Country	:	US
Telephone Number	:	919-496-5734
Fax Number	:	919-496-2599

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DONGHOON LEE
Credential	:	DMD
Telephone Number	:	919-496-5734

Provider Enumeration Date	:	05/17/2014
Last Update Date	:	05/17/2014

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