MEDICARE: DR. JAMES EMMANUEL 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	122300000X	Dentist	1856629	MA

General Provider Information

NPI Number	:	1619384393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES EMMANUEL LEE DMD

Provider Business Mailing Address
First Line	:	572 PLEASANT ST
Second Line	:
City	:	MALDEN
State	:	MA
Zip	:	02148-3550
Country	:	US
Telephone Number	:	781-397-8876
Fax Number	:	781-324-7166

Provider Business Practice Location Address
First Line	:	572 PLEASANT ST
Second Line	:
City	:	MALDEN
State	:	MA
Zip	:	02148-3550
Country	:	US
Telephone Number	:	781-397-8876
Fax Number	:	781-324-7166

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

Provider Enumeration Date	:	07/15/2014
Last Update Date	:	07/15/2014

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