Active NPI
Jennifer Lee
- General Practice Dentistry
- Bridgeport, CT
National Provider Identifier
1104512763
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 14789
- Practice address
- 161 Boston Ave
Bridgeport, CT 06610-1662 - Phone
- (203) 873-0598
- NPI assigned
- Apr 14, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 14789 | CT | Primary |
Addresses
Primary practice location
161 Boston Ave
Bridgeport, CT 06610-1662
Mailing address
1011 Washington Blvd Unit 601
Stamford, CT 06901-2224
Phone (512) 554-4102
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14789 | CT | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1681430400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1779840000000",
"number": "1104512763",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1011 WASHINGTON BLVD UNIT 601",
"city": "STAMFORD",
"state": "CT",
"postal_code": "069012224",
"telephone_number": "512-554-4102"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "161 BOSTON AVE",
"city": "BRIDGEPORT",
"state": "CT",
"postal_code": "066101662",
"telephone_number": "203-873-0598"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "JENNIFER",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-04-14",
"last_updated": "2026-05-27",
"certification_date": "2026-05-27",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CT",
"license": "14789",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bridgeport, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.