Provider Demographics
NPI:1730271248
Name:ANDERSON, LEE RYAN (DDS)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:RYAN
Last Name:ANDERSON
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 1:909 HUNT ROAD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:14750
Mailing Address - Country:US
Mailing Address - Phone:716-763-1110
Mailing Address - Fax:
Practice Address - Street 1:909 HUNT ROAD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NY
Practice Address - Zip Code:14750
Practice Address - Country:US
Practice Address - Phone:716-763-1110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030385122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist