Provider Demographics
NPI:1144606310
Name:LEE, RAYANNE (DMD)
Entity type:Individual
Prefix:
First Name:RAYANNE
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 BERGEN STREET RUTGERS SCHOOL OF DENTAL MEDICINE
Mailing Address - Street 2:DEPARTMENT OF ORTHODONTICS - ROOM C781
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103
Mailing Address - Country:US
Mailing Address - Phone:973-972-4704
Mailing Address - Fax:973-972-9402
Practice Address - Street 1:110 BERGEN STREET, RUTGERS SCHOOL OF DENTAL MEDICINE
Practice Address - Street 2:DEPARTMENT OF ORTHODONTICS - ROOM C781
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103
Practice Address - Country:US
Practice Address - Phone:973-972-4704
Practice Address - Fax:973-972-9402
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI026028001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics