NPIMap

Individual provider Active NPI

Jaerim Lee

  • Dentist
  • Lynnfield, MA
National Provider Identifier
1417372368
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN1857481 Issued in MA
Practice address
15 Post Office SQ
Lynnfield, MA 01940-2263
Phone
(781) 592-1650
NPI assigned
Mar 3, 2014
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DN1857481 MA Primary

Addresses

Primary practice location

15 Post Office SQ
Lynnfield, MA 01940-2263

Mailing address

1 Iron Works Way
Saugus, MA 01906-1488
Phone (704) 658-6595

Other practice location 1

100 Amesbury St Ste 203
Lawrence, MA 01840-1321
Phone (978) 686-8500

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

LicenseStateTypeSpecialty
DN1857481MAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Randall L Davis DMD PC Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1393804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1417372368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 IRON WORKS WAY",
            "city": "SAUGUS",
            "state": "MA",
            "postal_code": "019061488",
            "telephone_number": "704-658-6595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 POST OFFICE SQ",
            "city": "LYNNFIELD",
            "state": "MA",
            "postal_code": "019402263",
            "telephone_number": "781-592-1650"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Amesbury St Ste 203",
            "address_purpose": "LOCATION",
            "city": "Lawrence",
            "state": "MA",
            "postal_code": "018401321",
            "country_code": "US",
            "telephone_number": "978-686-8500",
            "fax_number": "978-686-8500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEE",
        "first_name": "JAERIM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-03-03",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "DN1857481",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lynnfield, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.