Provider Demographics
NPI:1144481094
Name:LEE, JUNG HO (DMD)
Entity type:Individual
Prefix:
First Name:JUNG
Middle Name:HO
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 1:463 WORCESTER RD
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-5356
Mailing Address - Country:US
Mailing Address - Phone:508-820-7792
Mailing Address - Fax:508-872-5483
Practice Address - Street 1:463 WORCESTER RD
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-5356
Practice Address - Country:US
Practice Address - Phone:508-820-7792
Practice Address - Fax:508-872-5483
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA221601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice