Provider Demographics
NPI:1861987182
Name:LEE, JUNSUP (DDS)
Entity type:Individual
Prefix:
First Name:JUNSUP
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4240 BALMORAL DR SW STE 200
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5633
Mailing Address - Country:US
Mailing Address - Phone:256-348-5085
Mailing Address - Fax:
Practice Address - Street 1:4240 BALMORAL DR SW STE 200
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5633
Practice Address - Country:US
Practice Address - Phone:256-348-5085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6541122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist