Provider Demographics
NPI:1265531867
Name:LEE, CHOONG M (DMD)
Entity type:Individual
Prefix:DR
First Name:CHOONG
Middle Name:M
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 1:1450 PARKSIDE AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08638-2948
Mailing Address - Country:US
Mailing Address - Phone:609-883-2053
Mailing Address - Fax:609-883-2054
Practice Address - Street 1:1450 PARKSIDE AVE STE 2
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08638-2948
Practice Address - Country:US
Practice Address - Phone:609-883-2053
Practice Address - Fax:609-883-2054
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ136211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice