Williamsburg Dental PLLC

Primary specialty

DentistTaxonomy code 122300000X

License

053083 Issued in NY

Legal business name

WILLIAMSBURG DENTAL PLLC

Practice address

202 Union Ave
D
Brooklyn, NY 11211-1739

Phone

(718) 388-4613

Fax

(718) 388-4613

NPI assigned

Aug 7, 2013

Last updated

Nov 19, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. David Formosan Lee, DDS

Title

President

Phone

(718) 388-4613

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1375833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384819200000",
    "number": "1881026292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 UNION AVE",
            "address_2": "D",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112111739",
            "telephone_number": "718-388-4613",
            "fax_number": "718-388-4613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 UNION AVE",
            "address_2": "D",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112111739",
            "telephone_number": "718-388-4613",
            "fax_number": "718-388-4613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAMSBURG DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-07",
        "last_updated": "2013-11-19",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "FORMOSAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-388-4613",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "053083",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02907899",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Dentist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2013; 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.