Organization
FORMOSO DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID FORMOSAN LEE DDS (PRESIDENT)
(718) 388-4613
Entity
Organization
Contact information
Practice address
30 E 40TH ST RM 305, NEW YORK, NY 10016-1247
(212) 370-1919
Mailing address
202 UNION AVE, D, BROOKLYN, NY 11211-1739
(718) 388-4613
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
053083
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02907899
—
NY
Enumeration date
01/08/2014
Last updated
11/10/2020
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