Provider Demographics
NPI:1174797013
Name:LEE, DONG HOON (DMD)
Entity type:Individual
Prefix:
First Name:DONG HOON
Middle Name:
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 1:109 JOLLY ST
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:27549-2239
Mailing Address - Country:US
Mailing Address - Phone:919-496-5734
Mailing Address - Fax:919-496-2599
Practice Address - Street 1:109 JOLLY ST
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549-2239
Practice Address - Country:US
Practice Address - Phone:919-496-5734
Practice Address - Fax:919-496-2599
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0371741223G0001X
NC9417122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice