Individual
LEE R CARRASCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD DDS
Contact information
Practice address
3400 SPRUCE STREET, 5 WHITE BUILDING, PHILADELPHIA, PA 19104
(215) 662-3580
Mailing address
3400 SPRUCE STREET, 5 WHITE BUILDING, PHILADELPHIA, PA 19104
(215) 662-3580
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
DS031585L
PA
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
MD418924
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0018942480001
—
PA
Enumeration date
06/30/2006
Last updated
04/10/2013
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