Provider Demographics
NPI:1730835505
Name:LEE, DONNY DOWON (DMD)
Entity type:Individual
Prefix:
First Name:DONNY
Middle Name:DOWON
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 1:4 OCONNOR LN
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-2798
Mailing Address - Country:US
Mailing Address - Phone:862-323-3631
Mailing Address - Fax:
Practice Address - Street 1:4 OCONNOR LN
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-2798
Practice Address - Country:US
Practice Address - Phone:862-323-3631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1859289122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist