Bryan D Lee, DDS, MD

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

M-11482 Issued in ID

Practice address

360 E. Main St.
Rexburg, ID 83440

Phone

(208) 356-5959

Fax

(208) 356-5559

NPI assigned

Apr 26, 2007

Reactivated

Aug 16, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jul 1, 2026 through Jul 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1177545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1432857600000",
    "number": "1790905495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 E. MAIN ST.",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "83440",
            "telephone_number": "208-356-5959",
            "fax_number": "208-356-5559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 E. MAIN ST.",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "83440",
            "telephone_number": "208-356-5959",
            "fax_number": "208-356-5559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "BRYAN",
        "middle_name": "D",
        "credential": "DDS, MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-26",
        "last_updated": "2015-05-29",
        "deactivation_date": "2007-07-17",
        "reactivation_date": "2007-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D-3542",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "ID",
            "license": "D-3542-OS",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "ID",
            "license": "M-11482",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806068200",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brennen Larsen, PA-C
• Emily Larson, LMT
• Michael J Larson, MD
• Jarrod Kieth Laub, LAMFT
• LDS Family Services
• Kevin M Lee, M.D.
• Legranderx Pharmacy LLC
• John David Lewis
• Sarah Lewis
• Scott Richard Lewis, DDS

• Oral & Maxillofacial Surgery (D.M.D.) in Rexburg, ID
• Providers in Rexburg, ID by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.