MEDICARE: EUNICE LEE

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	019.037202	IL

General Provider Information

NPI Number	:	1780510446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUNICE LEE

Provider Business Mailing Address
First Line	:	602 SHAWN LN
Second Line	:
City	:	PROSPECT HEIGHTS
State	:	IL
Zip	:	60070-1664
Country	:	US
Telephone Number	:	630-246-0795
Fax Number	:

Provider Business Practice Location Address
First Line	:	1730 W GOLF RD
Second Line	:
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-4071
Country	:	US
Telephone Number	:	847-357-9850
Fax Number	:

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

Provider Enumeration Date	:	06/22/2026
Last Update Date	:	06/22/2026

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Directions to “ EUNICE LEE ” Practice Location

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