Individual
KYLE KYOUNGROH LEE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
199 MAIN ST, DEEP RIVER, CT 06417-2021
(860) 526-9519
Mailing address
199 MAIN ST, DEEP RIVER, CT 06417-2021
(860) 526-9519
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
14130
CT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/06/2023
Last updated
09/13/2024
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