Provider Demographics
NPI:1447249792
Name:LEE, CLARA (DDS)
Entity type:Individual
Prefix:DR
First Name:CLARA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WATERSIDE PLZ
Mailing Address - Street 2:LOBBY LEVEL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-2602
Mailing Address - Country:US
Mailing Address - Phone:212-683-6260
Mailing Address - Fax:212-686-0460
Practice Address - Street 1:10 WATERSIDE PLZ
Practice Address - Street 2:LOBBY LEVEL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-2602
Practice Address - Country:US
Practice Address - Phone:212-683-6260
Practice Address - Fax:212-686-0460
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0465221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice