MEDICARE: DR. CYRUS F. LEE JR. D.D.S.

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	4722	NC

General Provider Information

NPI Number	:	1437134145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CYRUS F. LEE JR. D.D.S.

Provider Business Mailing Address
First Line	:	118 BRENTWOOD CENTER LN N
Second Line	:
City	:	WILSON
State	:	NC
Zip	:	27896-1710
Country	:	US
Telephone Number	:	252-243-2554
Fax Number	:	252-243-2327

Provider Business Practice Location Address
First Line	:	118 BRENTWOOD CENTER LN N
Second Line	:
City	:	WILSON
State	:	NC
Zip	:	27896-1710
Country	:	US
Telephone Number	:	252-243-2554
Fax Number	:	252-243-2327

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

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	07/08/2007

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