Provider Demographics
NPI:1487988689
Name:LEE, WING CHEONG (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:WING CHEONG
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:DR
Other - First Name:ANDREW WING CHEONG
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, MD
Mailing Address - Street 1:203 TURNPIKE ST
Mailing Address - Street 2:SUITE G-2
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-5042
Mailing Address - Country:US
Mailing Address - Phone:978-682-5255
Mailing Address - Fax:978-682-0656
Practice Address - Street 1:203 TURNPIKE ST
Practice Address - Street 2:SUITE G-2
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-5042
Practice Address - Country:US
Practice Address - Phone:978-682-5255
Practice Address - Fax:978-682-0656
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-22
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18563861223S0112X
MA253936204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery