NPIMap

Individual provider Active NPI

Jerry Lee, DMD

  • Dentist
  • Woodbury, MN
National Provider Identifier
1447772371
Registry record updated Feb 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
6972 Issued in OK
Practice address
683 Bielenberg Dr Ste 205
Woodbury, MN 55125-1715
Phone
(651) 200-4747
NPI assigned
Jul 12, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 6972 OK Primary

Addresses

Primary practice location

683 Bielenberg Dr Ste 205
Woodbury, MN 55125-1715

Mailing address

683 Bielenberg Dr Ste 205
Woodbury, MN 55125-1715
Phone (651) 200-4747

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

Practice roles

OrganizationSpecialtyStatusNew patients
Aces Dental Current Accepting new patients
Okc Dental Health Associates, P.C. Past Accepting new patients
Summer Dental Stillwater, PLLC PastSince Aug 16, 2020 Accepting new patients

Locations

683 Bielenberg Dr
Ste 205
Woodbury, MN 55125
Phone (651) 200-4747

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1499817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612483200000",
    "number": "1447772371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "683 BIELENBERG DR STE 205",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551251715",
            "telephone_number": "651-200-4747",
            "fax_number": "651-998-1009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "683 BIELENBERG DR STE 205",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551251715",
            "telephone_number": "651-200-4747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "JERRY",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-07-12",
        "last_updated": "2021-02-05",
        "certification_date": "2020-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OK",
            "license": "6972",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbury, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2021; 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.