Provider Demographics
NPI:1023154259
Name:LEE, YOUNG H (DMD)
Entity type:Individual
Prefix:DR
First Name:YOUNG
Middle Name:H
Last Name:LEE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11481 OLD SAINT AUGUSTINE RD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-1473
Mailing Address - Country:US
Mailing Address - Phone:904-262-1737
Mailing Address - Fax:
Practice Address - Street 1:11481 OLD SAINT AUGUSTINE RD
Practice Address - Street 2:SUITE 401
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-1473
Practice Address - Country:US
Practice Address - Phone:904-262-1737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 123421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL593703419OtherEIN