Steven B Lee, DDS, PC

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

12008803 Issued in IN

Legal business name

STEVEN B LEE, DDS, PC

Practice address

1320 Medical Park Dr
Fort Wayne, IN 46825-5844

Phone

(260) 471-1222

Fax

(260) 471-1724

NPI assigned

Apr 11, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Steven B Lee, DDS

Title

President

Phone

(260) 471-1222

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1144713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208217600000",
    "number": "1629031372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1320 MEDICAL PARK DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468255844",
            "telephone_number": "260-471-1222",
            "fax_number": "260-471-1724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1320 MEDICAL PARK DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468255844",
            "telephone_number": "260-471-1222",
            "fax_number": "260-471-1724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEVEN B LEE, DDS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-11",
        "last_updated": "2008-04-15",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "260-471-1222",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "IN",
            "license": "12008803",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "000000373783",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Periodontics in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Periodontics in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2008; 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.